D-dimer level influences thromboembolic events in patients with atrial fibrillation.

Abstract

BACKGROUND:

Elevated coagulative molecular markers could reflect the prothrombotic state in the cardiovascular system of patients with non-valvular atrial fibrillation (NVAF). A prospective, cooperative study was conducted to determine whether levels of coagulative markers alone or in combination with clinical risk factors could predict subsequent thromboembolic events in patients with NVAF.

METHODS:

Coagulative markers of prothrombin fragment 1+2, D-dimer, platelet factor 4, and beta-thromboglobulin were determined at the enrollment in the prospective study.

RESULTS:

Of 509 patients with NVAF (mean age, 66.6 +/- 10.3 years), 263 patients were treated with warfarin (mean international normalized ratio, 1.86), and 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significantly better in patients with D-dimer level < 150 ng/ml than in those with D-dimer level>or==150 ng/ml. Other coagulative markers, however, did not predict thromboembolic events. Age (>or==75 years), cardiomyopathies, and prior stroke or transient ischemic attack were independent, clinical risk factors for thromboembolism. Thromboembolic risk in patients without the clinical risk factors was quite low (0.7%/year) when D-dimer was < 150 ng/ml, but not low (3.8%/year) when D-dimer was >or==150 ng/ml. It was >5%/year in patients with the risk factors regardless of D-dimer levels. This was also true when analyses were confined to patients treated with warfarin.

CONCLUSIONS:

D-dimer level in combination with clinical risk factors could effectively predict subsequent thromboembolic events in patients with NVAF even when treated with warfarin.

• Authors: Takashi Nozawa, Hiroshi Inoue, Tadakazu Hirai, Atsushi Iwasa, Ken Okumura, Jong-Dae Lee, Akihiko Shimizu, Motonobu Hayano, Katsusuke Yano
• Journal: International journal of cardiology (Int J Cardiol) Vol. 109 Issue 1 Pg. 59-65 (Apr 28 2006) ISSN: 0167-5273 [Print] Netherlands
• PMID: 15992948 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Biomarkers
• Fibrin Fibrinogen Degradation Products
• Peptide Fragments
• beta-Thromboglobulin
• fibrin fragment D
• prothrombin fragment 1.2
• Platelet Factor 4
• Warfarin
• Prothrombin

Topics

• Aged
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (blood, complications)
• Biomarkers (blood)
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Peptide Fragments (blood)
• Platelet Factor 4 (analysis)
• Predictive Value of Tests
• Prospective Studies
• Prothrombin
• Stroke (etiology, prevention & control)
• Thromboembolism (blood, etiology, prevention & control)
• Warfarin (therapeutic use)
• beta-Thromboglobulin (analysis)