Prognostic Value of Red Blood Cell Distribution Width on Bleeding Events in Nonvalvular Atrial Fibrillation Patients Taking Dabigatran (110 mg b.i.d.) after Catheter Ablation

Abstract

Objectives: Recent research has indicated that red blood cell distribution width (RDW) is associated with the prognosis of cardiovascular diseases such as chronic heart failure and coronary heart disease. We aimed to study the predictive value of RDW for bleeding events in patients with nonvalvular atrial fibrillation (NVAF) during the administration of 110 mg of dabigatran twice a day after catheter ablation. Methods: One hundred and seventy-two NVAF patients who were hospitalized and received catheter ablation in Jiangsu Provincial People's Hospital from January 2014 to January 2015 were enrolled (110 mg of dabigatran was administered orally to outpatients preoperatively twice a day for 3 weeks). The enrolled patients were divided into the high RDW (>12.8%) group (n = 85) and the low RDW (≤12.8%) group (n = 87) according to the median RDW. The activated partial thromboplastin time (APTT) at dabigatran trough concentration was also detected. Patients were followed up for 3 months to observe the occurrence of bleeding events, and the predictive value of RDW as well as APTT for bleeding events was assessed from receiver-operating characteristic (ROC) analyses. Results: In all patients, preoperatively, no bleeding events were observed and the APTT did not exceed twice the normal upper limit. Thirteen cases of bleeding events, all minor bleeding, occurred after a 3-month follow-up: 3 of gingival bleeding, 3 of urinary tract bleeding, 3 conjunctival hemorrhages and 4 subcutaneous hemorrhages. The incidence of bleeding events in the low RDW group was lower than in the high RDW group (3.4 vs. 11.8%, p = 0.039). The areas under the ROC curve for RDW and APTT to predict the occurrence of bleeding events were 0.737 (cutoff point 13.25%; p < 0.05) and 0.558 (p > 0.05), respectively. Conclusion: RDW was associated with the occurrence of bleeding events in NVAF patients on dabigatran (110 mg twice a day) after ablation, while also being an independent predictor of bleeding events. RDW had superior predictive value for bleeding events over APTT when APTT did not exceed twice the normal upper limit.

Red Cell Distribution Width and Hemorrhagic Events Related to Dabigatran Use

“…However, as they themselves state, their study had its limitations, the most important being the short follow-up time (3 months) and the use of only a low dose of dabigatran (110 mg twice a day). They found only minor hemorrhages (13 cases) in their study population [1]. We wonder if the outcome would have been the same with a 150-mg dose dabigatran or if patients had been followed for a longer time.…”

“…We read the paper by Zhang et al [1], entitled ‘‘Prognostic Value of Red Blood Cell Distribution Width on Bleeding Events in Nonvalvular Atrial Fibrillation Patients Taking Dabigatran (110 mg b.i.d.) after Catheter Ablation'' in this issue of Cardiology , with great interest, and we thank them for their striking investigation.…”

“…The investigation by Zhang et al [1] is a well-designed research study. The investigators discovered that RDW could predict hemorrhagic complications in patients taking dabigatran.…”

“…It is also well known that the side effects of dabigatran, including bleeding, are closely related to its plasma concentrations [5]. Zhang et al [1 ]found that patients with a high RDW had a significantly lower creatinine clearance than those with a low RDW. Although there is no linear relationship between RDW and creatinine clearance, the low creatinine clearance could have led to the high plasma concentration of dabigatran in the patients with a high RDW.…”

“…However, if more patients had been included in the study, perhaps a reverse linear correlation between RDW and creatinine clearance would have been observed. On the other hand, Table 1 of Zhang et al [1] shows that the high-RDW group had a lower hemoglobin level, were of advanced age, and were predominantly female. These findings support that the mechanism underlying a high RDW may be multifactorial.…”