Abstract
Limitation of the anticoagulants apixaban is the availability of specific antidotes with many adverse effects. Reversal allows acute bleeding events to be managed or urgent interventional procedures performed. Spinacia oleracea L. is a source of vitamin K, oral anticoagulants exert their effect by blocking the utilization of vitamin K, yet little is known about competitive aspects of their interaction with dietary vitamin K. This study is designed to determine in an animal model whether the leaves of S. oleracea (source of vitamin K) ethanol extract can potentiate the effect of prothrombin complex concentrate (PCC) in the reversal of the anticoagulation effect of apixaban. Anesthetized rabbits (n=5) were divided in to following groups, Group 1: Normal saline (negative control); other groups treated with 0.04 mg/kg apixaban, followed by Group II: Normal saline; Group III: 50 IU kg(-1) PCC; Group IV: S. oleracea leaves ethanol extract test doses of 150 mg/kg + 50 IU kg(-1) PCC. After a standardized kidney incision, the volume of blood loss and time to hemostasis were determined. From the above study, we may conclude that the herbal leaves of S. oleracea. which may reduce the prothrombin time and blood loss and potentiate the effect of prothrombin complex concentrate in reversing apixaban. Further, investigation is warranted.