Left atrial thrombus resolution in non-valvular atrial fibrillation or flutter: biomarker substudy results from a prospective study with rivaroxaban (X-TRA)

Miyazawa, Kazuo; Pastori, Daniele; Hammerstingl, Christoph; Cappato, Riccardo; Meng, Isabelle Ling; Cohen, Ariel; Schulz, Anke; Eickels, Martin van; Lip, Gregory Y.H.; Marin, Francísco

doi:10.1080/07853890.2018.1495337

Cited by 16 publications

(21 citation statements)

References 46 publications

(32 reference statements)

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“…[22][23][24][25][26] The decrease of the mentioned biomarkers during rivaroxaban treatment has also been shown in a similar study in AF. 16 Here, von Willebrand's factor (vWF) and plasminogen activator inhibitor-1 were measured at baseline and after 6 weeks of treatment in addition to the biomarkers described here. The hs-CRP, D-dimer, vWF, and TAT showed a significant decrease in the mean levels from baseline to end of treatment with rivaroxaban.…”

Section: Discussionmentioning

confidence: 99%

“…In the X-TRA biomarker substudy, high levels of inflammatory biomarkers in patients with AF who had left atrial/left atrial appendage thrombus were associated with the thrombus being completely resolved or reduced with rivaroxaban treatment and, therefore, also showed potential as predictive biomarkers. 16 These correlates require additional investigation to assess their clinical utility.…”

Section: Discussionmentioning

confidence: 99%

“…14 The effects of rivaroxaban on selected biomarkers of coagulation have previously been demonstrated in patients with venous thromboembolism. 15,16 However, the effects of rivaroxaban on a combination of coagulation and inflammation biomarkers in patients with AF undergoing cardioversion have not yet been fully evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Rivaroxaban on Biomarkers of Coagulation and Inflammation: A Post Hoc Analysis of the X-VeRT Trial

Kirchhof

Ezekowitz

Purmah

et al. 2020

TH Open

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Introduction This X-VeRT (eXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in patients with nonvalvular aTrial fibrillation scheduled for cardioversion) substudy evaluated the effects of treatment with rivaroxaban or a vitamin-K antagonist (VKA) on levels of biomarkers of coagulation (D-dimer, thrombin–antithrombin III complex [TAT] and prothrombin fragment [F1.2]) and inflammation (high sensitivity C-reactive protein [hs-CRP] and high-sensitivity interleukin-6 [hs-IL-6]) in patients with atrial fibrillation (AF) who were scheduled for cardioversion and had not received adequate anticoagulation at baseline (defined as, in the 21 days before randomization: no oral anticoagulant; international normalized ratio <2.0 with VKA treatment; or <80% compliance with non-VKA oral anticoagulant treatment). Methods Samples for biomarker analysis were taken at baseline (n = 958) and treatment completion (42 days after cardioversion; n = 918). The influence of clinical characteristics on baseline biomarker levels and the effect of treatment on changes in biomarker levels were evaluated using linear and logistic models. Results Baseline levels of some biomarkers were significantly associated with type of AF (D-dimer and hs-IL-6) and with history of congestive heart failure (hs-CRP, D-dimer, and hs-IL-6). Rivaroxaban and VKA treatments were associated with reductions from baseline in levels of D-dimer (−32.3 and −37.6%, respectively), TAT (−28.0 and −23.1%, respectively), hs-CRP (−12.5 and −17.9%, respectively), and hs-IL-6 (−9.2 and −9.8%, respectively). F1.2 levels were reduced from baseline in patients receiving a VKA (−53.0%) but not in those receiving rivaroxaban (2.7%). Conclusion Anticoagulation with rivaroxaban reduced levels of key inflammation and coagulation biomarkers to a similar extent as VKAs, with the exception of F1.2. Further investigation to confirm the value of these biomarkers in patients with AF is merited.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of Rivaroxaban on Biomarkers of Coagulation and Inflammation: A Post Hoc Analysis of the X-VeRT Trial

Kirchhof

Ezekowitz

Purmah

et al. 2020

TH Open

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“…In ammation has been con rmed to be associated with left atrial thrombosis in AF patients [20]. Previous studies have found that in ammatory biomarkers were signi cantly associated with left atrium or left atrial appendage thrombus outcomes in AF patients [21]. In conclusion, LDL-C/HDL-C may cause IS in NVAF patients by promoting atherosclerosis and left atrial or left atrial appendage thrombosis.…”

Section: Discussionmentioning

confidence: 79%

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

Zhang

Meng

Shang

et al. 2020

Preprint

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Background This study explored relationships between low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in non-valvular atrial fibrillation (NVAF) patients in Xinjiang, which could provide a theoretical and therapeutic basis for patients with NVAF. Methods NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into the stroke (798 patients) and control (2671 patients) groups according to whether acute IS occurred. Univariate and multivariate logistic regression analysis was used to examine the independent risk factors for IS in NVAF patients. We used factor analysis and principal component regression analysis to analyse the main influencing factors of IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal cut-off value of LDL-C/HDL-C in predicting IS. Results Multivariate logistic regression showed that the risk of IS in the highest quartile of LDL-C/HDL-C (≥ 2.73) was 16.23-fold that in the lowest quartile (< 1.22); IS risk was 2.27-fold higher in obese patients (BMI ≥ 28 kg/m2) than in normal-weight subjects; IS risk was 3.15-fold higher in smoking than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, optimal critical value was 2.33, sensitivity was 63.53%, and specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients. Conclusions LDL-C/HDL-C > 1.22, smoking and BMI ≥ 24 kg/m2 were independent risk factors for IS in NVAF patients, of which LDL-C/HDL-C was the main risk factor.

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“…In ammation has been con rmed to be associated with left atrial thrombosis in AF patients [28]. Previous studies have found that in ammatory biomarkers are signi cantly associated with left atrium or left atrial appendage thrombus outcomes in AF patients [29]. In conclusion, LDL-C/HDL-C may cause IS in NVAF patients by promoting atherosclerosis and left atrial or left atrial appendage thrombosis.…”

Section: Discussionmentioning

confidence: 81%

LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study

Zhang

Meng

Shang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: This study explored the relationships between the low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in patients with non-valvular atrial fibrillation (NVAF) in Xinjiang. The findings could provide a theoretical and therapeutic basis for NVAF patients.Methods: NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into stroke (798 patients) and control (2671 patients) groups according to the occurrence of first acute IS occurred. Univariate and multivariate logistic regression analysis were used to examine the independent risk factors for IS in NVAF patients. Factor analysis and principal component regression analysis were used to analyse the main factors influencing IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of LDL-C/HDL-C for predicting the occurrence of IS.Results: The stroke group had an average age of 71.64 ± 9.96 years and included 305 females (38.22%). The control group had a mean age of 67.30 ± 12.01 years and included 825 females (30.89%). Multivariate logistic regression showed that the risk of IS in the highest LDL-C/HDL-C quartile ( ≥2.73) was 16.23-fold that of the lowest quartile ( < 1.22); IS risk was 2.27-fold higher in obese patients than in normal-weight subjects; IS risk was 3.15-fold higher in smoking patients than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, the optimal critical value was 2.33, the sensitivity was 63.53%, and the specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients.Conclusions: LDL-C/HDL-C >1.22, smoking, BMI ≥24 kg/m2 and CHA2DS2-VASc score were independent risk factors for IS in NVAF patients; LDL-C/HDL-C was the main risk factor.

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Left atrial thrombus resolution in non-valvular atrial fibrillation or flutter: biomarker substudy results from a prospective study with rivaroxaban (X-TRA)

Abstract: Biomarkers of inflammation are significantly associated with LA/LAA thrombus outcomes in AF patients prospectively treated with rivaroxaban.

Cited by 16 publications

References 46 publications

Effects of Rivaroxaban on Biomarkers of Coagulation and Inflammation: A Post Hoc Analysis of the X-VeRT Trial

Effects of Rivaroxaban on Biomarkers of Coagulation and Inflammation: A Post Hoc Analysis of the X-VeRT Trial

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study

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