Determination of rivaroxaban in rat plasma by ultra-high-performance liquid chromatography-Q-Orbitrap high-resolution mass spectrometry and its application to a pharmacokinetic study.

Therapeutic drug monitoring is critical to decrease the incidence rate of bleeding and thrombosis for personalized treatment with rivaroxaban, especially for drug interaction treatment, patients with renal dysfunction, elderly patients, patients with cardiovascular problems, and so on. In addition, an accurate analytical method is necessary for therapeutic drug monitoring. This study developed a ultra-HPLC-tandem Orbitrap high-resolution MS (UHPLC-Q-Orbitrap HRMS) method to accurately identify and quantify rivaroxaban in rat plasma. The isotope internal standard method was applied for accurate quantification. Rivaroxaban-d4 was selected as the isotope internal standard substance. The m/z 436.07263 ([M + H]+ ) was selected as the precursor ion and m/z 144.95085 and m/z 231.11259 were selected as the main product ions for rivaroxaban. The lower limit of quantification of rivaroxaban in plasma was 0.01 mg/L. The intra- and inter-day precisions were ≤3.65% and ≤8.16%, while the recoveries ranged from 87.4% to 95.2%. This analysis method was simple, low cost, and easy to operate. The developed and validated method was subsequently applied to successfully investigate the pharmacokinetic parameters of rivaroxaban in rats after its oral administration. These results could be helpful to promote further research regarding the mechanisms of rivaroxaban and drug interaction, which can avoid false positives due to high-precision identification of the proposed method.

Effects of Compound Danshen Dripping Pills on Ventricular Remodeling and Cardiac Function after Acute Anterior Wall ST-Segment Elevation Myocardial Infarction (CODE-AAMI): Protocol for a Randomized Placebo-Controlled Trial.

BACKGROUND: Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction (AAMI) is an important factor in occurrence of heart failure which additionally results in poor prognosis. Therefore, the treatment of ventricular remodeling needs to be further optimized. Compound Danshen Dripping Pills (CDDP), a traditional Chinese medicine, exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction. OBJECTIVE: This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale. METHODS: This study is a multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The total of 268 patients with AAMI after primary percutaneous coronary intervention (pPCI) will be randomly assigned 1:1 to the CDDP group (n=134) and control group (n=134) with a follow-up of 48 weeks. Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction (STEMI), with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI, and the control group treated with a placebo simultaneously. The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide (NT-proBNP) level, arrhythmias, and cardiovascular events (death, cardiac arrest, or cardiopulmonary resuscitation, rehospitalization due to heart failure or angina pectoris, deterioration of cardiac function, and stroke). Investigators and patients are both blinded to the allocated treatment. DISCUSSION: This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI. Patients in the CDDP group will be compared with those in the control group. If certified to be effective, CDDP treatment in AAMI will probably be advised on a larger scale. (Trial registration No. NCT05000411).