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July 11, 2026Journal of Thrombosis and Thrombolysis

Antiplatelet effects of oral anticoagulants in patients with atrial fibrillation: ex-vivo studies

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Why the study?

Do direct oral anticoagulants exert differential ex-vivo antiplatelet effects compared to warfarin and untreated controls in patients with atrial fibrillation?

Population

125 patients, comprising patients with atrial fibrillation treated with dabigatran, rivaroxaban, apixaban…

Comparison

Direct oral anticoagulants: dabigatran… vs Vitamin K antagonist or no treatment

Design

Cross-sectional

Key result

Factor Xa inhibitors demonstrated more marked antiplatelet activity, including reduced thromboxane generation and platelet aggregation, compared to dabigatran in patients with atrial fibrillation.

Authors

GRGiulia RendaVBValentina BucciarelliGBGiulia Barbieri

Discussion

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Overview

DOAC platelet effects in AF remain hypothesis-generating; larger prospective studies needed before clinical consideration.

Key Points

  • To assess the impact of direct oral anticoagulants on platelet function in atrial fibrillation patients.
  • Conducted an observational study comparing various DOACs: dabigatran, rivaroxaban, apixaban, edoxaban, and warfarin.
  • Evaluated thrombin generation, platelet aggregation, serum thromboxane, and receptor expressions.
  • Included a total of 103 patients: 22 on dabigatran, 20 on rivaroxaban, 22 on apixaban, 12 on edoxaban, 26 on warfarin, and 23 untreated controls.
  • Thrombin generation was reduced in patients on FXa inhibitors and warfarin compared to controls.
  • Rivaroxaban and apixaban significantly reduced LTA compared to controls with all agonists.
  • Dabigatran-treated patients showed a higher proportion of activated platelets expressing P-selectin than controls.

Study Design

Type

Observational (n=125)

Structured PICO

Do direct oral anticoagulants exert differential ex-vivo antiplatelet effects compared to warfarin and untreated controls in patients with atrial fibrillation?

P
Population
125 patients, including those with atrial fibrillation treated with various oral anticoagulants and untreated controls without AF, evaluated for platelet function.
E
Exposure
Direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban, or edoxaban
C
Comparator
Vitamin K antagonist (warfarin) or no treatment (untreated patients without AF as controls)
O
Outcome
Platelet function assessed by thrombin generation, light transmittance platelet aggregation (LTA), serum thromboxane (TX) generation, and expression of PAR-1 and P-selectin on the platelet surfacesurrogate

Factor Xa inhibitors demonstrate more pronounced ex-vivo antiplatelet effects compared to the direct thrombin inhibitor dabigatran in patients with atrial fibrillation.

Cite This Study

Renda et al. (2026) conducted an observational in Atrial fibrillation (n=125). Direct oral anticoagulants (DOACs) and warfarin vs. Untreated patients without atrial fibrillation was evaluated on Platelet function (thrombin generation, platelet aggregation, thromboxane generation, and receptor expression). Factor Xa inhibitors demonstrated more marked antiplatelet activity, including reduced thromboxane generation and platelet aggregation, compared to dabigatran in patients with atrial fibrillation.

synapsesocial.com/papers/6a51e4bfc18d7f28ca501716https://doi.org/10.1007/s11239-026-03356-7
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