Increased Level of Thrombotic Biomarkers in Patients with Atrial Fibrillation Despite Traditional and New Anticoagulant Therapy

Abstract

The aim of this study was to examine the effect of the traditional oral anticoagulant, warfarin (W), and new anticoagulants, apixaban (A) and rivaroxaban (R), on the level of thrombotic biomarkers in patients with atrial fibrillation (AF). Circulating plasma levels of von Willebrand factor (vWF), prothrombin fragment 1.2 (F1.2), microparticle tissue factor (MP-TF), and plasminogen activator inhibitor (PAI-1) were analyzed as potential markers of clot formation in 30 patients with AF prior to ablation surgery. Patients with AF were divided into 2 groups based on their usage (n = 21) and nonusage (n = 9) of any oral anticoagulant. Furthermore, those on anticoagulants were divided based on their use of newer (R and A, 16) or traditional (W, 4) anticoagulants. A statistical increase (P < .05) in the levels of vWF, MP-TF, and PAI-1 were seen in anticoagulated patients with AF, whereas F1.2 and PAI-1 were increased in nonanticoagulated patients with AF compared to normal. There was no statistical difference (P > .05) in levels of any thrombotic biomarker between patients treated with the traditional anticoagulant, W, and those treated with new anticoagulants, R and A. Our data suggest that, despite the use of traditional or newer anticoagulants, prothrombotic biomarkers are still generated at increased levels in patients with AF. Further studies to confirm these findings are warranted.

Outcomes in anticoagulated patients with atrial fibrillation and with mitral or aortic valve disease

“…On one hand, it was suggested that the high shear stress associated with severe MR might decrease von Willebrand factor activity 14. On the other hand, concomitant AF complicates the picture, since it is associated with increased von Willebrand factor, even in patients on vitamin K antagonists, rivaroxaban or apixaban 15. We observed a modestly lower rate of major bleeding in patients with MR compared with those with no VHD.…”

Fibrinolytic Deficit and Platelet Activation in Atrial Fibrillation and Their Postablation Modulation

“…Previous studies by Liles et al have examined the use and effects of antithrombotic drugs in patient with AF and shown the drugs’ effects in downregulating the levels of various thrombotic biomarkers. 18 These results, when compared and combined with the current data from this study, may yield important information that will have clinical implications in both the diagnosis and treatment of AF.…”

“…17 This elevated inflammatory state has been implicated in both the progression of AF and the increased risk of thrombotic events in these patients. 18…”

Von Willebrand Factor: Multimeric Structure and Functional Activity in Patients With Atrial Fibrillation With and Without Oral Anticoagulation

“…41 The addition of vWF plasma levels to the clinical risk stratification data has shown an independent association between high levels of vWF and the risk of a vascular event. 8,22 CHADS 2 score does not include many common stroke risk factors. Given the need to be more inclusive of common stroke risk factors, many studies have confirmed the ability of CHA 2 DS 2 -VASc to identify "low-risk" patients.…”