Sarah Bos

42 CHAPTER 3 Dabigatran addition decreased thrombin generation in both control and patient plasma, but the extend of inhibition was N2-fold greater in patient plasma, as expressed by the ETP (Fig. 1). Inhibition of thrombin generation by dabigatran appeared less in obese control subjects com- pared to lean controls. In addition, dabigatran prolonged the lag-time similarly in all patient groups (table 2). Furthermore, dabigatran inhibited peak thrombin generation and the velocity index in patients, whereas these were not inhibited in controls. The inhibition of thrombin generation by dabigatran appeared higher in patients with ASH-related cirrhosis compared to patients with NASH-related cirrhosis, which may be related to the higher MELD score in the ASH- cirrhosis group. Addition of apixaban had virtually identical effects on thrombin generation parameters in all groups. Apixaban decreased ETP (Fig. 1), peak thrombin generation, and velocity index in all groups to a similar extent (lean peak, 28.3% (22–34); obese peak, 28.3% (24–30); NASH peak 28.7% (22–35); ASH peak, 23.4% (21–29); lean velocity, 26.6% (19–35); obese velocity, 25.9% (19–32); NASH velocity, 28.5% (22– 36); ASH velocity, 21.7% (16–33))whereas the lag-time was not affected (lean 0.0% (0–0); obese, 6.7% (0–12); NASH, 8.5% (7–15); ASH, 9.2% (0– 17)). LMWH decreased ETP (Fig. 1), peak, velocity index, but not lag time in all groups (lean peak, 28.8% (23 − 33); obese peak, 36.4% (24– 42); NASH peak, 26% (17–32); ASH peak, 17.7% (13–25); lean velocity, 26.1 (21–26); obese velocity, 37.1% (24–47); NASH velocity, 27.6% (15–35); ASH velocity, 17.3% (11–28); lean lag-time, 0% (0–0); obese lag-time, 0% (0–0); NASH lag-time, 0% ( − 7.1–0); ASH lag-time, 0% (0–0)). The capacity of LMWH to inhibit thrombin generation appeared increased in obese compared to lean controls. In contrast, compared to controls, LMWH was less effective in reducing thrombin generation in patients with cirrhosis, in particular those with ASH-related cirrhosis.