Global Thrombosis Test - a possible monitoring system for the effects and safety of dabigatran

© Otsui et al. 2015BACKGROUND: Dabigatran is an alternative to warfarin (WF) for the thromboprophylaxis of stroke in patients with non-valvular atrial fibrillation (NVAF). The advantage of dabigatran over WF is that monitoring is not required; however, a method to monitor the effect and the safety of dabigatran is not currently available. The Global Thrombosis Test (GTT) is a novel method to assess both clot formation and lysis activities under physiological conditions. OBJECTIVE: The aim of this study was to evaluate whether treatment with dabigatran might affect shear-induced thrombi (occlusion time [OT], sec) by the GTT, and to investigate the possibility that the GTT could be useful as a monitoring system for dabigatran. PATIENTS/METHODS: The study population consisted of 50 volunteers and 43 NVAF patients on WF therapy, who were subsequently switched to dabigatran. Using the GTT, the thrombotic status was assessed one day before and 1 month after switching anticoagulation from WF to dabigatran. RESULTS: The OT was 524.9 ± 17.0 sec in volunteers whereas that of NVAF patients on WF therapy was 581.7 ± 26.3 sec. The switch from WF to dabigatran significantly prolonged OT (784.5 ± 19.3 sec). One patient on WF therapy and 12 patients on dabigatran therapy were shown to have OT > 900 sec. CONCLUSION: The GTT could be used to assess the risk of dabigatran-related bleeding complications.Peer reviewe

Cardiovascular risk assessment using LOX-index and Self-Rating Depression Scale

Objective: LOX-Index is a novel biomarker for cardiovascular disease (CVD) and is calculated by multiplying LOX-1 ligands containing apolipoprotein B (LAB) and soluble LOX-1 (sLOX-1). The Framingham risk score (FRS) is a common clinical tool for risk assessment of coronary artery disease. Mental stress can also be an important risk factor for CVD. The purpose of this study was to examine the relationship between LOX-Index and FRS or mental stress. Methods: LOX-Index was measured in 453 subjects including 150 consecutive outpatients with lifestyle-related diseases such as diabetes, hyperlipidemia, and hypertension and 303 healthy volunteers. Mental stress was evaluated by the Self-Rating Depression Scale (SDS). Results: LOX-Index was significantly related with the 10-years risk of FRS. Multiple regression analysis demonstrated that LAB was closely associated with the smoking status, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). There were no significant associations between LOX-Index and the SDS scores; however, by simultaneously using LOX-Index and SDS, the subjects could be classified in terms of oxidative stress and mental stress. Conclusions: LOX-Index appears to be a comprehensive marker that could evaluate the status of multiple CVD risk factors. The classification with LOX-Index and SDS could contribute to the risk assessment for CVD