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Scridon A, Balan AI. Challenges of Anticoagulant Therapy in Atrial Fibrillation-Focus on Gastrointestinal Bleeding. Int J Mol Sci 2023; 24:ijms24086879. [PMID: 37108042 PMCID: PMC10138869 DOI: 10.3390/ijms24086879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The rising prevalence and the complexity of atrial fibrillation (AF) pose major clinical challenges. Stroke prevention is accompanied by non-negligible risks, making anticoagulant treatment an ongoing challenge for the clinician. Current guidelines recommend direct oral anticoagulants (DOACs) over warfarin for stroke prevention in most AF patients, mainly due to the ease of their use. However, assessing the bleeding risk in patients receiving oral anticoagulants remains-particularly in the case of DOACs-highly challenging. Using dose-adjusted warfarin increases threefold the risk of gastrointestinal bleeding (GIB). Although the overall bleeding risk appears to be lower, the use of DOACs has been associated with an increased risk of GIB compared to warfarin. Accurate bleeding (including GIB-specific) risk scores specific for DOACs remain to be developed. Until then, the assessment of bleeding risk factors remains the only available tool, although the extent to which each of these factors contributes to the risk of bleeding is unknown. In this paper, we aim to provide a comprehensive review of the bleeding risk associated with oral anticoagulant therapy in AF patients, with a highlight on the latest insights into GIB associated with oral anticoagulation; we emphasize questions that remain to be answered; and we identify hotspots for future research.
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Affiliation(s)
- Alina Scridon
- Physiology Department, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Alkora Ioana Balan
- Physiology Department, University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureș, 540142 Târgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, 540136 Târgu Mureș, Romania
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Platelets and Their Role in Hemostasis and Thrombosis-From Physiology to Pathophysiology and Therapeutic Implications. Int J Mol Sci 2022; 23:ijms232112772. [PMID: 36361561 PMCID: PMC9653660 DOI: 10.3390/ijms232112772] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 02/21/2023] Open
Abstract
Hemostasis is a physiological process critical for survival. Meanwhile, thrombosis is amongst the leading causes of death worldwide, making antithrombotic therapy one of the most crucial aspects of modern medicine. Although antithrombotic therapy has progressed tremendously over the years, it remains far from ideal, and this is mainly due to the incomplete understanding of the exceptionally complex structural and functional properties of platelets. However, advances in biochemistry, molecular biology, and the advent of 'omics' continue to provide crucial information for our understanding of the complex structure and function of platelets, their interactions with the coagulation system, and their role in hemostasis and thrombosis. In this review, we provide a comprehensive view of the complex role that platelets play in hemostasis and thrombosis, and we discuss the major clinical implications of these fundamental blood components, with a focus on hemostatic platelet-related disorders and existing and emerging antithrombotic therapies. We also emphasize a number of questions that remain to be answered, and we identify hotspots for future research.
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Scridon A, Mărginean A, Huțanu A, Chinezu L, Gheban D, Perian M, Vântu A, Gherțescu D, Fișcă PC, Șerban RC, Chevalier P, Dobreanu D. Vascular protease-activated receptor 4 upregulation, increased platelet aggregation, and coronary lipid deposits induced by long-term dabigatran administration - results from a diabetes animal model. J Thromb Haemost 2019; 17:538-550. [PMID: 30653813 DOI: 10.1111/jth.14386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 12/22/2022]
Abstract
Essentials The impact of long-term thrombin inhibition outside the coagulation cascade is far from clear. We aimed to assess the impact of dabigatran etexilate (DE) in diabetic and control rats. In diabetic rats, DE increased platelet aggregation and lead to coronary lipid deposits. Long-term thrombin inhibition may increase atherosclerotic and atherothrombotic risk. SUMMARY: Background Besides its role in the coagulation cascade, thrombin contributes to platelet aggregation and to a plethora of non-hemostatic functions. Objectives To assess the impact of long-term thrombin inhibition with dabigatran etexilate (DE) on platelet aggregation and on extrahemostatic thrombin-related functions in diabetic and control rats. Methods Markers of inflammation, endothelial dysfunction, oxidative stress, angiogenesis and cell adhesion molecules were quantified in control rats (Control; n = 6), DE-treated control rats (Control-Dabi; n = 8), diabetic rats (Diabetes; n = 5), and DE-treated diabetic rats (Diabetes-Dabi; n = 8). Agonist-induced platelet aggregation, aortic and coronary lipid deposits and aortic protease-activated receptor 4 (PAR4) expression were also assessed. Results Control-Dabi rats showed significantly higher high-sensitivity C-reactive protein, von Willebrand factor (VWF), vascular endothelial growth factor (VEGF) and fibronectin levels, and significantly lower PAR4 agonist-induced aggregation, than Control rats. Control-Dabi rats also showed mild aortic lipid deposits, whereas no such changes were observed in Control rats. Diabetes-Dabi rats showed significantly higher VWF, VEGF and fibronectin levels than Diabetes rats, and similar PAR4 agonist-induced aggregation as Diabetes rats, and significantly higher ADP-induced aggregation than Diabetes rats. Coronary lipid deposits were observed in 75% of Diabetes-Dabi rats and in none of the Diabetes rats. PAR4 expression was 20.4% higher in Control-Dabi rats and 27.4% higher in Diabetes-Dabi rats than in their non-treated peers. Conclusions This study indicates that long-term thrombin inhibition increases vascular PAR4 expression, promotes atherosclerosis-related mechanisms, and, in diabetic rats, increases platelet aggregation and favors the occurrence of coronary lipid deposits. These experimental data suggest that long-term thrombin inhibition may increase atherosclerotic and atherothrombotic risk, particularly in the presence of diabetes.
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Affiliation(s)
- Alina Scridon
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Center for Advanced Medical and Pharmaceutical Research, Tîrgu Mureș, Romania
| | - Alina Mărginean
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Military Hospital 'Dr Constantin Papilian', Cluj-Napoca, Romania
| | - Adina Huțanu
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Center for Advanced Medical and Pharmaceutical Research, Tîrgu Mureș, Romania
| | - Laura Chinezu
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Histopathological Department, Forensic Medicine Institute of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - Dan Gheban
- Pathology Department, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Perian
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - Adriana Vântu
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
| | - Doina Gherțescu
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Paul C Fișcă
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | - Rǎzvan C Șerban
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
| | | | - Dan Dobreanu
- University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
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