Anticoagulant therapy presents iatrogenic effects such as
intracerebral hemorrhage (ICH). The latest
anticoagulants on the market, direct oral
anticoagulants (DOACs) such as
apixaban,
dabigatran and
rivaroxaban, are reported to cause less ICH than other
anticoagulants. Next to the ICH area, the
thrombin is accumulated and the blood-brain barrier (BBB) is opened. The effects of
thrombin on the BBB are largely mediated by the
protease activated receptor (PAR) family, especially the PAR-1
isoform. Our hypothesis is that DOACs may limit the effects of
thrombin on endothelial cells (of the BBB) alteration by a mechanism probably involving PAR-1 activation. To test this hypothesis in vitro, we used HBEC-5i human brain endothelial cells as a human BBB model. The effects of
thrombin under
warfarin,
heparin,
rivaroxaban,
apixaban, and
dabigatran treatment on endothelial cells were then investigated by measuring of permeability and junction
proteins: ZO-1 and
VE-cadherin expressions and PAR-1 cleavage. Depending on the
anticoagulant used, we observed three profiles of response of the endothelial cells after
thrombin exposure: i)
dabigatran treatment allowed maintaining the tightness of the endothelial monolayer; ii) other DOACs limited
thrombin-induced alteration of the endothelial monolayer; and iii) pretreatment with
warfarin and
heparin did not protect from
thrombin-induced BBB breakdown. Pretreatment with DOACs clearly limited the impact of
thrombin on PAR-1 cleavage in our model, contrary to other
anticoagulants, associated with ZO-1 and
VE-cadherin expressions. In conclusion, DOACs seem to limit the alteration of the monolayer of endothelial cells of the BBB mediated by the
thrombin/PAR-1 pathway.