Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

Abstract

Background Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation. Methods We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters. Results After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003–1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910–0.986; P = 0.008) were potential predictors of high LA D-dimer levels. Conclusions In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF.

The Association between Coagulation and Atrial Fibrillation

“…Tests involving D-dimer, prothrombin fragment F1 + 2, and left-ventricular ejection fraction (LVEF) can be useful in verifying hypercoagulability in patients with AF who are undergoing DOAC treatment. The results indicate that the effectiveness of apixaban as an anticoagulant might be superior to that of edoxaban in patients with NVAF, as demonstrated by lower levels of left-atrial D-dimer in the apixaban group, compared to the edoxaban group [78].…”

Impact of Off-Label Under-Dose Direct Oral Anticoagulant on Coagulation and Fibrinolytic Markers in Patients with Atrial Fibrillation

“…F1 + 2 is a peptide liberated from prothrombin when it is converted to thrombin by activated factor X (FXa). It re ects thrombin production and is a coagulation activation marker [22,23]. A previous study of patients administered DOAC therapy revealed that inappropriate underdosing was a risk factor for recurrent ischemic stroke [24].…”