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Protective, repairing and fibrinolytic effects of rivaroxaban on vascular endothelium.

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Published:22nd Sep 2017
Author: Álvarez E, Paradela-Dobarro B, Raposeiras-Roubín S, González-Juanatey JR.
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Ref.:Br J Clin Pharmacol. 2017.

Rivaroxaban, a direct inhibitor of activated factor X (FXa), is the only new oral anticoagulant approved for secondary prevention after acute coronary syndrome. Our objective was to identify the possible molecular mechanisms of rivaroxaban that contributes to endothelial function.

Methods: Cell viability and growth of human umbilical vein endothelial cells (HUVEC) were registered. Gene expression studies comparing the effects of rivaroxaban and FXa were conducted by a selective RNA array and confirmed by protein quantification. Wound-healing experiments on HUVEC, platelet adhesion, enzymatic activity, and cell-based assays for fibrin formation were performed with rivaroxaban.

Results: Rivaroxaban (50 nM) only altered (>2 fold change) the expression of matrix metallopeptidase 2 and urokinase plasminogen activator (u-PA), but counteracted the FXa (9 nM)-induced up-regulation of several pro-inflammatory genes (p < 0.05) and FXa-enhanced platelet adhesion over HUVEC. Rivaroxaban increased u-PA protein expression in HUVEC supernatants and enhanced u-PA activity (up to 4 IU/ng of u-PA). Rivaroxaban (1 nM - 1 μM) showed a significant and dose-dependent positive effect on HUVEC growth that was inhibited by BC-11-hydroxibromide, an inhibitor of u-PA. Healing properties after a wound on HUVEC cultures, and fibrinolytic properties were also showed by rivaroxaban. Both effects were reverted by BC-11-hydroxibromide.

Conlusions: Rivaroxaban enhanced viability, growth and migration of HUVEC, mainly by u-PA activation and up-regulation, which also participate in the rivaroxaban-induced fibrinolytic activity at endothelial level. Rivaroxaban also protected from the pro-inflammatory effects of FXa on HUVEC. Altogether may improve endothelial functionality and could contribute to the cardiovascular benefits of rivaroxaban.


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