Interventional studies 12.2021 Dr. med. Frank Pistrosch

Type 2 diabetes

New insights into the impact of the direct factor Xa inhibitor rivaroxaban on endothelial function in patients with type 2 diabetes and high cardiovascular risk.

Patients with type 2 diabetes mellitus and subclinical inflammation have stimulated coagulation, activated platelets, and endothelial dysfunction.

Recent studies with the direct factor Xa inhibitor rivaroxaban in combination with low-dose aspirin showed a significant reduction in serious cardiovascular events, particularly in individuals with type 2 diabetes and established cardiovascular disease. Therefore, the question was raised whether treatment with rivaroxaban could affect endothelial function, arterial stiffness, and platelet activation. A multicenter, prospective, randomized, open-label study was conducted in 179 participants with type 2 diabetes, subclinical inflammation (high-sensitivity C-reactive protein 2-10 mg/l), and at least two features of the metabolic syndrome. Twenty-week treatment with rivaroxaban (n = 89) resulted in significant improvement in forearm postischemic blood flow, numerically increased skin blood flow, and decreased plasma soluble P-selectin levels compared with aspirin. Significant differences in arterial stiffness or other biomarkers were not observed. Neither rivaroxaban nor aspirin affected platelet VASP phosphorylation. Rivaroxaban was associated with a higher number of bleeding events. These results suggest that the direct factor Xa inhibitor rivaroxaban improves endothelial function in participants with type 2 diabetes and subclinical inflammation but also increases bleeding risk.

Rivaroxaban compared with low-dose aspirin in individuals with type 2 diabetes and high cardiovascular risk: a randomised trial to assess effects on endothelial function, platelet activation and vascular biomarkers. Pistrosch F, Matschke JB, Schipp D, Schipp B, Henkel E, et al. Diabetologia. 2021 Dec;64(12):2701-2712.

GWT-TUD GmbH, Faculty of Medicine, Technical University, Dresden, Germany.


Dr. med. Frank Pistrosch

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