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Hachenberger M, Yeniguen M, Suenner L, Hinchliffe D, Mueller C, Wietelmann A, Gerriets T, Tschernatsch M, Juenemann M, Gerner ST, Doeppner TR, Huttner HB, Braun T. Comparison of edoxaban and enoxaparin in a rat model of AlCl 3-induced thrombosis of the superior sagittal sinus. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:3887-3892. [PMID: 37261475 PMCID: PMC10643418 DOI: 10.1007/s00210-023-02546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
Cerebral sinus venous thrombosis (CSVT) is an uncommon disease that is usually treated with anticoagulation (heparin, low-molecular heparin, or vitamin K-antagonists). We compared treatment with edoxaban, an oral factor Xa-antagonist, that has not been approved in patients with CSVT, with enoxaparin, a well-established therapy, in a rat model of CSVT. Fifty male Wistar rats were randomized into 5 groups (10 animals each) and subjected to aluminum chloride (AlCl3)-induced thrombosis of the superior sagittal sinus (SSS) or sham procedure. Animals with thrombosis of the SSS were treated with edoxaban, enoxaparin, or placebo. Diagnostic workup included neurological examination, MRI imaging, MR-flow measurements of the SSS, and immunohistochemical staining. Neurological examination revealed no differences between treatment groups. Seven days after initial thrombosis, flow in the SSS was lower in the active treatment group as compared to sham-operated animals (p < 0.05). Flow in the SSS in the active treatment groups (edoxaban 1 h prior to thrombosis: 0.16 cm/s ± 0.06 cm/s; edoxaban 6 h after thrombosis: 0.13 cm/s ± 0.05 cm/s; enoxaparin: 0.13 cm/s ± 0.04 cm/s; placebo: 0.07 cm/s ± 0.02 cm/s) was higher as compared to placebo (p < 0.05), but there were no differences between the active treatment groups (p > 0.05). Immunohistochemical staining showed no differences in the actively treated animals. Edoxaban proved to be similar to enoxaparin in a model of experimental AlCl3-induced CSVT.
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Affiliation(s)
- M Hachenberger
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - M Yeniguen
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- NeuroCentrum Wetzlar, Sportparkstrasse 2, 35578, Wetzlar, Germany
| | - L Suenner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - D Hinchliffe
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
| | - C Mueller
- Department of Radiology, Kerckhoff-Klinik Bad Nauheim, 61231, Bad Nauheim, Germany
| | - A Wietelmann
- Scientific Service Group Magnetic Resonance Imaging, Max Planck Institute for Heart and Lung Research, 61231, Bad Nauheim, Germany
| | - T Gerriets
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- "Die Neurologen", Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - M Tschernatsch
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
- "Die Neurologen", Private Practice, Frankfurter Strasse 34, 61231, Bad Nauheim, Germany
| | - M Juenemann
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Heart and Brain Research Group, 35385, Giessen, Germany
| | - S T Gerner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - T R Doeppner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
- Department of Neurology, University of Goettingen Medical School, 37075, Goettingen, Germany
| | - H B Huttner
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University Giessen, 35032, Marburg, Germany
| | - T Braun
- Department of Neurology, Justus-Liebig University Giessen, Klinikstraße 33, 35385, Giessen, Germany.
- Heart and Brain Research Group, 35385, Giessen, Germany.
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Prolongation of clot lysis time by a direct thrombin inhibitor melagatran mediated by paradoxical enhancement of thrombin generation: comparison with a direct factor Xa inhibitor edoxaban. Blood Coagul Fibrinolysis 2021; 32:209-215. [PMID: 33560005 DOI: 10.1097/mbc.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previously, we reported that a direct thrombin inhibitor melagatran paradoxically increased thrombin generation in human plasma in the presence of thrombomodulin. The aim of this study is to test the hypothesis that melagatran may exert a deleterious effect on tissue-type plasminogen activator (t-PA)-induced fibrinolysis via enhancement of thrombin generation and subsequent activation of thrombin-activatable fibrinolysis inhibitor (TAFI) and factor XIII (FXIII). Clot formation in human plasma containing t-PA and thrombomodulin was induced by tissue factor. The absorbance at 405 nm was measured to obtain clot lysis time. Effects of melagatran and a factor Xa inhibitor edoxaban on clot lysis time were determined. In the presence of thrombomodulin, melagatran significantly prolonged clot lysis time, but edoxaban shortened it. In the absence of thrombomodulin, melagatran did not inhibit fibrinolysis. Prolongation of clot lysis time by melagatran was reversed by activated protein C (which suppressed thrombin generation increased by melagatran) and a TAFIa inhibitor. Melagatran significantly suppressed plasmin generation, while edoxaban significantly increased it. However, both melagatran and edoxaban suppressed FXIII activation. In the clot formed in the presence of melagatran and edoxaban, the fibrin fibre was thin compared with control, showing no clear difference in the clot structures between melagatran and edoxaban. These results indicated that melagatran, not edoxaban, prolonged clot lysis time through the paradoxical enhancement of thrombin generation, and subsequent TAFI activation and inhibition of plasmin generation. Neither FXIII activation nor change in fibrin clot structure contributed to the inhibition of fibrinolysis by melagatran.
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