Non-valvüler atriyal fibrilasyon hastalarında edoksaban tedavisi: Ortalama trombosit hacmi üzerinde paradoksal etki

Yıl 2023, , 209 - 215, 30.06.2023

İlke Erbay , Mert Aker , Ahmet Furkan Süner , Yeşim Akın , Orhan Önalan

https://doi.org/10.18663/tjcl.1267632

Öz

Araştırmanın konusu:
Atriyal fibrilasyon (AF) tedavisinde iskemik inmenin önlenmesi için artık yeni nesil oral antikoagülanlar (NOAK'lar) birinci basamak tedavi olarak tercih edilmektedir. Seçici ve geri dönüşümlü olarak pıhtılaşma faktörü Xa'nın aktivitesini bloke eden yeni nesil oral antikoagülanlardan biri olan edoxabanın, felç veya sistemik embolizmi önlemede varfarin kadar etkili olduğu, kanama ve kardiyovasküler nedenlerden ölüm oranları açısından daha düşük risk taşıdığı gösterilmiştir. Ortalama trombosit hacmi (OTH), trombosit aktivitesinin bir göstergesi olarak, AF'li hastalarda artmış iskemik inme riski ile ilişkilidir. Bu nedenle OTH'yi düşüren medikal tedaviler, iskemik istenmeyen olayları önlemede önemli bir rol oynuyor olabilir.
Amaç:
Bu çalışmanın amacı, edoksabanın iskemik inmeye karşı koruyucu antikoagülan etkisinin yanı sıra trombosit hacmi ve diğer platelet indeksleri üzerine etkisinin olup olmadığını belirlemektir.
Gereç ve Yöntem:
Çalışma retrospektif kesitsel çalışma olarak tasarlandı. Çalışmaya daha önce oral antikoagülan ilaç kullanım öyküsü olmayan 200 non-valvüler AF hastası dahil edildi. Hastane kayıt sisteminden edoksaban tedavisi başlanmadan önce çalışılan tam kan sayımı (TKS) ve temel biyokimya parametreleri (üre, kreatinin, kan elektrolitleri vb.) ile temel demografik veriler kayıt altına alındı. Hastaların ortalama 6 ay (184 ± 9 gün) sonra tekrarlanan TKS'leri incelenerek edoksaban tedavisi ve sonrası platelet indeksleri karşılaştırıldı. Bulgular ortalama ± standart sapma ve % oranıyla gösterildi. Veriler Student's t testi ve Wilcoxon testleri kullanılarak karşılaştırıldı. p<0.05 istatistiksel olarak anlamlı kabul edildi.
Bulgular:
Hastaların ortalama yaşı 74±9 yıldı. Çalışmaya katılan hastalarımızın çoğunluğu kadınlardan oluşmaktaydı (%52,5). Hastaların OTH değerlerindeki değişimi göz önünde bulundurarak, tedavi sonrası OTH değerinde anlamlı artış gözlendi [10,0 fL (6,0-13,8) vs. 10,2 fL (7,1-14,9), p=0,023]. OTH'de görülen bu artış 30mg/gün edoksaban kullanan grupta görülmezken (p=0,333), 60mg/gün kullanan grupta anlamlı artış izlendi (p=0.041). Ek olarak, OTH'de cinsiyetle ilgili bir değişiklik gözlenmedi. Edoxaban kullanımının altı aylık sürecinde kan trombosit sayısı (PLT) (p=0,863), trombosit dağılım genişliği (PDW) (p=0,085) veya trombokrit (PCT) (p=0,127) değerlerinde anlamlı değişiklikler gözlenmedİ.
Sonuç:
Ortalama trombosit hacminde saptanan bu artış, edoksabanın trombosit indeksleri üzerinde bilinmeyen pleiotropik etkilere sahip olabileceğini ve OTH'deki bu artışın herhangi bir klinik sonucu olup olmadığını belirlemek için ileri çalışmaların gerektiğini düşündürmektedir.

Anahtar Kelimeler

edoksaban, atriyal fibrilasyon, ortalama trombosit hacmi

Teşekkür

Çalışmanın istatistik aşamasındaki katkılarından dolayı Dr. Ahmet Furkan SÜNER'e çok teşekkür ederim.

Edoxaban therapy in non-valvular atrial fibrillation patients: Paradoxical effect on mean platelet volume

Öz

Introduction: New generation oral anticoagulants (NOACs), which selectively and reversibly block the activity of clotting factor Xa, are now preferred as first-line therapy for preventing ischemic stroke in the treatment of atrial fibrillation (AF). Edoxaban, one of these NOACs, has been shown to be as effective as warfarin in preventing stroke or systemic embolism, while carrying a lower risk of bleeding and cardiovascular death. Mean platelet volume (MPV), as an indicator of platelet activity, is associated with an increased risk of ischemic stroke in patients with AF. Therefore, medical therapies that reduce MPV may play an important role in preventing unwanted ischemic events.

Objective: The aim of this study is to determine whether edoxaban has an effect on platelet volume and other platelet indices, in addition to its protective anticoagulant effect against ischemic stroke.

Materials and Methods: The study was designed as a retrospective cross-sectional study. Two hundred non-valvular AF patients without a history of oral anticoagulant use were included in the study. Complete blood count (CBC) and basic biochemical parameters (urea, creatinine, electrolytes, etc.) were recorded from the hospital registration system before edoxaban treatment was started, along with basic demographic data. The CBCs of the patients were reevaluated an average of 6 months (184 ± 9 days) after edoxaban treatment initiation, and platelet indices after edoxaban treatment were compared. Results were presented as mean ± standard deviation and percentage. Data were compared using Student's t-test and Wilcoxon test, and p<0.05 was considered statistically significant.

Results: The mean age of the patients was 74±9 years. The majority of the patients in the study were female (52.5%). A significant increase in MPV value was observed after treatment [10.0 fL (6.0-13.8) vs. 10.2 fL (7.1-14.9), p=0.023], considering the change in MPV values of the patients. This increase in MPV was not observed in the group using 30mg/day edoxaban (p=0.333), while a significant increase was observed in the group using 60mg/day (p=0.041). In addition, no gender-related change was observed in MPV. No significant changes were observed in platelet count (PLT) (p=0.863), platelet distribution width (PDW) (p=0.085), or plateletcrit (PCT) (p=0.127) values during the six-month period of edoxaban use.

Conclusion: The observed increase in mean platelet volume suggests that edoxaban may have unknown pleiotropic effects on platelet indices, and further studies are needed to determine whether this increase in MPV has any clinical significance.

Anahtar Kelimeler

edoxaban, mean platelet volume, atrial fibrillation

Kaynakça

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