<i>D</i>-Dimer Levels in Combination with Clinical Risk Factors Can Effectively Predict Subsequent Thromboembolic Events in Patients with Atrial Fibrillation during Oral Anticoagulant Therapy

Abstract

Objectives: Atrial fibrillation (AF) is associated with hemostatic abnormality and increased risk of thromboembolic events. The aim of the present study was to evaluate whether elevated D-dimer levels in combination with clinical risk factors can adequately predict subsequent thromboembolic events in patients with AF. Method: This was a post hoc analysis of the single-center, prospective observational study. Consecutive patients with nonvalvular AF (245 patients, 74 ± 9 years) treated with warfarin were included. D-dimer levels were measured in combination with clinical risk factors to assess the relationship of this parameter with subsequent thromboembolic events. Results:D-dimer levels were elevated (≧0.5 µg/ml) in 55 (22%) patients. During an average follow-up time of 756 ± 223 days, 9 (1.8%/year) thromboembolic events occurred. Cox proportional hazard analysis showed that elevated D-dimer levels (hazard ratio, HR, 14.3, p < 0.01) as well as high CHADS₂ score (≧3; HR 9.43, p < 0.01) was associated with thromboembolic events. C-statistic improved to 0.848 from 0.781 when D-dimer level was added to the predictor model based on CHADS₂ score. Elevated D-dimer levels also predicted thromboembolic events in the subgroup of patients with high CHADS₂ score (n = 76, HR 12.1, p = 0.021). Conclusion: CHADS₂ scores and D-dimer level can be a useful marker of subsequent thromboembolic events in patients with AF during oral anticoagulant therapy and combination of these can effectively predict thromboembolic events.

Effect of Hyperthyroidism on the Hypercoagulable State and Thromboembolic Events in Patients with Atrial Fibrillation

“…Furthermore, numerous studies have shown that the D-dimer level can be a useful marker of the absence of left atrial appendage thrombi and subsequent embolic events in patients with NVAF, even during oral anticoagulation [15,16,17,18,19]. Meanwhile, in combination with CHADS 2 scores, the D-dimer level can effectively predict subsequent thromboembolic events in patients with NVAF [39,40].…”

“…The D-dimer level, a coagulative marker of thrombogenesis, was found to be increased in patients with nonvalvular AF (NVAF) [12,13] and notably increased along with the accumulation of clinical risk factors [14]. In addition, multiple studies have shown that D-dimer levels can effectively predict subsequent embolic events in patients with NVAF, even during oral anticoagulant therapy [15,16,17,18,19]. Matsumoto et al [20] demonstrated that the plasma D-dimer level was significantly associated with infarction volume and poor functional outcome in NVAF patients with cardioembolic stroke.…”

The predictive value of cardiac biomarkers in prognosis and risk stratification of patients with atrial fibrillation

“…The authors of this investigation concluded that patients with acute atrial fibrillation have increased thrombogenesis (fibrin D-dimer) which persists for at least 30 days after successful cardioversion [12]. Furthermore, D-dimer levels in combination with clinical risk factors can effectively predict subsequent thromboembolic events in patients with atrial fibrillation during oral anticoagulant therapy [50]. This suggests that D-dimer as a biomarker has potential value in predicting cardiovascular events that are related to endothelial damage as well as in predicting thromboembolic events in atrial fibrillation secondary to abnormal thrombogenesis.…”

NT-proBNP in “low risk” patients with atrial fibrillation

“…However, in our study the percentage of low risk patients (accordingly to the CHA 2 DS 2 -VASc score) with highest NT-proBNP was much higher than in the study performed by Hijazi and colleagues (14.3% versus 4.8%, respectively). It might be partly explained by the relatively small cohort in our pilot study, while another study analyzed patients from large anticoagulation trials.Several studies have demonstrated the usefulness of adding blood biomarkers to established clinical risk scores [6,7] but the application of this approach to the daily clinical practice still remains uncertain and the latest AF management guidelines [8] stress the focus on the identification of 'low' and 'truly low risk' patients who do not need any antithrombotic therapy. Therefore, the use of NT-proBNP might be clinically relevant to stratify the patients within the low risk CHA 2 DS 2 -VASc score 0 and 1.…”

“…Several studies have demonstrated the usefulness of adding blood biomarkers to established clinical risk scores [6,7] but the application of this approach to the daily clinical practice still remains uncertain and the latest AF management guidelines [8] stress the focus on the identification of 'low' and 'truly low risk' patients who do not need any antithrombotic therapy. Therefore, the use of NT-proBNP might be clinically relevant to stratify the patients within the low risk CHA 2 DS 2 -VASc score 0 and 1.…”