AUTHOR=Martins Gabriela Lopes , Duarte Rita Carolina Figueiredo , Vieira Érica Leandro Marciano , Rocha Natalia Pessoa , Figueiredo Estêvão Lanna , Silveira Francisco Rezende , Caiaffa José Raymundo Sollero , Lanna Rodrigo Pinheiro , Carvalho Maria das Graças , Palotás András , Ferreira Cláudia Natália , Reis Helton José 

TITLE=Comparison of Inflammatory Mediators in Patients With Atrial Fibrillation Using Warfarin or Rivaroxaban

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2020.00114

DOI=10.3389/fcvm.2020.00114

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Atrial fibrillation (AF) is the most common arrhythmia associated with high risk of venous thromboembolism. Inflammatory mechanisms may be involved in the pathophysiology of AF and in the AF-related thrombogenesis, and patients with AF might benefit from the use of anticoagulants with anti-inflammatory properties. However, the evidence is still scarce, and it points out the need of trials seeking to investigate the levels of inflammatory mediators in patients with AF under different anticoagulant therapies. Therefore, this study was designed to define whether patients with AF treated either with an activated coagulation factor X (FXa) inhibitor (rivaroxaban) or with a vitamin K inhibitor (warfarin) present changes in peripheral levels of inflammatory mediators, mainly cytokines and chemokines.</p><p><bold>Methods:</bold> A total of 127 subjects were included in this study, divided into three groups: patients with non-valvular atrial fibrillation (NVAF) using warfarin (<italic>N</italic> = 42), patients with NVAF using rivaroxaban (<italic>N</italic> = 29), and controls (<italic>N</italic> = 56). Plasma levels of inflammatory mediators were quantified by immunoassays.</p><p><bold>Results:</bold> Patients with AF (both warfarin and rivaroxaban groups) presented increased levels of inflammatory cytokines in comparison with controls. The use of rivaroxaban was associated with decreased levels of inflammatory cytokines in comparison with warfarin. On the other hand, patients with AF using rivaroxaban presented increased levels of the chemokines (MCP-1 in comparison with warfarin users; MIG and IP-10 in comparison with controls).</p><p><bold>Conclusions:</bold> AF is associated with an inflammatory profile that was less pronounced in patients on rivaroxaban in comparison with warfarin users. Further studies are necessary to assess the clinical implications of our results and whether patients with AF would benefit from rivaroxaban anti-inflammatory effects.</p>