Thromb Haemost 2010; 104(06): 1242-1249
DOI: 10.1160/TH09-10-0744
Animal Models
Schattauer GmbH

Evaluation of AR-H067637, the active metabolite of the new direct thrombin inhibitor AZD0837, in models of venous and arterial thrombosis and bleeding in anaesthetised rats

Susanne Pehrsson
1   AstraZeneca R&D, Mölndal, Sweden
,
Karin Johansson
1   AstraZeneca R&D, Mölndal, Sweden
,
Magnus Kjaer
1   AstraZeneca R&D, Mölndal, Sweden
,
Margareta Elg
1   AstraZeneca R&D, Mölndal, Sweden
› Author Affiliations
Financial support:AstraZeneca, Mölndal, Sweden, supported this study.
Further Information

Publication History

Received: 30 October 2009

Accepted after major revision: 30 July 2010

Publication Date:
24 November 2017 (online)

Summary

AZD0837, currently in clinical development, is a once-daily oral anticoagulant that is bioconverted to AR-H067637, a selective, reversible direct thrombin inhibitor (DTI). When developing a new DTI, the anti-thrombotic effects are commonly investigated in in vivo animal models; this report shows the effect of AR-H067637 in venous and arterial thrombosis and bleeding models in anaesthetised rats. Thrombus formation was induced by topical application of ferric chloride to the carotid artery or to the caval vein with partial stasis. Cutaneous incision bleeding time and muscle transection blood loss were assessed, with or without acetylsalicylic acid (ASA). Activated partial thromboplastin time (APTT), ecarin coagulation time (ECT) and thrombin coagulation time (TCT) were used as plasma biomarkers of anticoagulant effect. Dalteparin was used as a reference compound. AR-H067637, given by continuous infusion, displayed a dose-dependent antithrombotic effect, with 50% inhibition (IC50) of thrombus size in venous and arterial thrombosis models obtained at plasma concentrations of 0.13 μM and 0.55 μM, respectively, without increased bleeding. Dose-dependent increased bleeding and blood loss were seen at plasma concentrations ≥1 μM AR-H067637. At the highest AR-H067637 plasma concentration tested, bleeding time and blood loss increased two and four times the vehicle group. Addition of ASA moderately potentiated bleeding time and blood loss. APTT, ECT and TCT were dose-dependently prolonged. These studies demonstrate that the DTI AR-H067637 inhibits thrombus formation in rat venous and arterial thrombosis models with no or minor increases in bleeding.

* Footnote: Parts of this study were presented previously at the XXIst Congress of the International Society on Thrombosis and Haemostasis Geneva, 2007; Abstract P-W-637.


 
  • References

  • 1 Schafer AI, Levine MN, Konkle BA. et al. Thrombotic Disorders: Diagnosis and Treatment. Hematology Education Program Book 2003; 1: 520-539.
  • 2 Waldo AL. Anticoagulation: stroke prevention in patients with atrial fibrillation. Med Clin North Am 2008; 92: 143-159 xi.
  • 3 Hirsh J, Bauer KA, Donati MB. et al. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 141S-159S.
  • 4 Boos CJ, Lip GY. Ximelagatran: an eulogy. Thromb Res 2006; 118: 301-304.
  • 5 Nishio H, Ieko M, Nakabayashi T. New therapeutic option for thromboembolism--dabigatran etexilate. Expert Opin Pharmacother 2008; 9: 2509-2517.
  • 6 Borris LC. New compounds in the management of venous thromboembolism after orthopedic surgery: focus on rivaroxaban. Vasc Health Risk Manag 2008; 4: 855-862.
  • 7 Connolly SJ, Ezekowitz MD, Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151.
  • 8 Ansell J, Hirsh J, Hylek E. et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 160S-198S.
  • 9 South A, Iveson E, Allgar V. et al. The under use of thromboprophylaxis in older medical in-patients: a regional audit. QJM 2007; 100: 685-689.
  • 10 Olsen TS, Rasmussen BH, Kammersgaard LP. et al. Strokes attributable to underuse of warfarin and antiplatelets. J Stroke Cerebrovasc Dis 2005; 14: 55-57.
  • 11 Crawley JT, Zanardelli S, Chion CK. et al. The central role of thrombin in hemostasis. J Thromb Haemost 2007; 5 (Suppl. 01) 95-101.
  • 12 Gurm HS, Bhatt DL. Thrombin, an ideal target for pharmacological inhibition: a review of direct thrombin inhibitors. Am Heart J 2005; 149: S43-S53.
  • 13 Weitz JI. Factor Xa or thrombin: is thrombin a better target?. J Thromb Haemost 2007; 5: 65-67.
  • 14 Lip GYH, Rasmussen LH, Olsson SB. et al. Oral direct thrombin inhibitor AZD0837 for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation: a randomised dose-guiding, safety and tolerability study of four doses of AZD0837 versus vitamin K antagonists. Eur Heart J 2009; 30: 2897-2907.
  • 15 Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development. Clin Pharmacokinet 2009; 48: 1-22.
  • 16 Olsson SB, Rasmussen LH, Tveit A. et al. Safety and tolerability of an immediate-release formulation of the oral direct thrombin inhibitor AZD0837 in the prevention of stroke and systemic embolism in patients with atrial fibrillation. Thromb Haemost 2010; 103: 604-612.
  • 17 Deinum J, Mattsson C, Inghardt T. et al. Biochemical and pharmacological effects of the direct thrombin inhibitor AR-H067637. Thromb Haemost 2009; 101: 1051-1059.
  • 18 Pinheiro J, Bates D, Debrov S. et al. The R development core team (2007). nlme: Linear and nonlinear mixed effects models. R-package version 3.1–86. http://CRAN.R-project.org/package=nlme. 2007
  • 19 R Development Core Team.. A language and environment for statistical computing. 2008
  • 20 Elg M, Gustafsson D, Deinum J. The importance of enzyme inhibition kinetics for the effect of thrombin inhibitors in a rat model of arterial thrombosis. Thromb Haemost 1997; 78: 1286-1292.
  • 21 Kurz KD, Main BW, Sandusky GE. Rat model of arterial thrombosis induced by ferric chloride. Thromb Res 1990; 60: 269-280.
  • 22 Zhou J, May L, Liao P. et al. Inferior vena cava ligation rapidly induces tissue factor expression and venous thrombosis in rats. Arterioscler Thromb Vasc Biol 2009; 29: 863-869.
  • 23 Brass LF. Thrombin and platelet activation. Chest 2003; 124: 18S-25S.
  • 24 Nylander S, Mattsson C. Thrombin-induced platelet activation and its inhibition by anticoagulants with different modes of action. Blood Coagul Fibrinolysis 2003; 14: 159-167.
  • 25 Berry CN, Girard D, Lochot S. et al. Antithrombotic actions of argatroban in rat models of venous, ‘mixed’ and arterial thrombosis, and its effects on the tail transection bleeding time. Br J Pharmacol 1994; 113: 1209-1214.
  • 26 Schumacher WA, Bostwick JS, Stewart AB. et al. Effect of the direct factor Xa inhibitor apixaban in rat models of thrombosis and hemostasis. J Cardiovasc Pharmacol 2010; 55: 609-616.
  • 27 Elg M, Gustafsson D, Carlsson S. Antithrombotic effects and bleeding time of thrombin inhibitors and warfarin in the rat. Thromb Res 1999; 94: 187-197.
  • 28 Patrono C, Baigent C, Hirsh J. et al. Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 199S-233S.
  • 29 Wallentin L, Wilcox RG, Weaver WD. et al. Oral ximelagatran for secondary prophylaxis after myocardial infarction: the ESTEEM randomised controlled trial. Lancet 2003; 362: 789-797.
  • 30 Ravanat C, Freund M, Dol F. et al. Cross-reactivity of human molecular markers for detection of prethrombotic states in various animal species. Blood Coagul Fibrinolysis 1995; 6: 446-455.
  • 31 Markwardt F, Hoffman J, Korbs E. The influence of synthetic thrombin inhibitors on the thrombin-antithrombin reaction. Thromb Res 1973; 2: 343-348.
  • 32 Rapaport SI, Vermylen J, Hoylaerts M. et al. The multiple faces of the partial thromboplastin time APTT. J Thromb Haemost 2004; 2: 2250-2259.
  • 33 Liesenfeld KH, Schafer HG, Troconiz IF. et al. Effects of the direct thrombin inhibitor dabigatran on ex vivo coagulation time in orthopaedic surgery patients: a population model analysis. Br J Clin Pharmacol 2006; 62: 527-537.
  • 34 Mueck W, Eriksson BI, Bauer KA. et al. Population pharmacokinetics and pharmacodynamics of rivaroxaban--an oral, direct factor Xa inhibitor--in patients undergoing major orthopaedic surgery. Clin Pharmacokinet 2008; 47: 203-216.
  • 35 Wienen W, Stassen JM, Priepke H. et al. In-vitro profile and ex-vivo anticoagulant activity of the direct thrombin inhibitor dabigatran and its orally active prodrug, dabigatran etexilate. Thromb Haemost 2007; 98: 155-162.
  • 36 Nowak G. The ecarin clotting time, a universal method to quantify direct thrombin inhibitors. Pathophysiol Haemost Thromb 2003; 33: 173-183.
  • 37 Carlsson SC, Mattsson C, Eriksson UG. et al. A review of the effects of the oral direct thrombin inhibitor ximelagatran on coagulation assays. Thromb Res 2005; 115: 9-18.