The association of coagulation and atrial fibrillation: a systematic review and meta-analysis

Abstract

Aims While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies. Methods and results We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00–1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00–1.12), and d-dimer (HR 1.10, 95% CI 1.02–1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20–0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28–1.66), P-selectin (SMD 0.31, 95% CI 0.08–0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61–1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12–0.7), PAI-1 (1.73, 95% CI 0.26–3.19), and d-dimer (SMD 1.74, 95% CI 0.36–3.11) in AF patients, as opposed to controls. Conclusion These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development.

Genetically predicted systemic inflammation and the risk of atrial fibrillation: A bidirectional two-sample Mendelian randomization study

“…Fbg is an acute-phase reactant that responds to inflammatory processes or tissue damage and serves as a maker for prothrombotic state. Previous observational studies have demonstrated higher levels of Fbg in AF cases compared to healthy individuals [49] , which contradicts our finding. In observational studies, the levels of Fbg could be influenced by the confounding risk factors of AF and the coexistence of other cardiovascular diseases, potentially leading to an overestimation of Fbg concentration.…”

Asymmetric Dimethylarginine Is Associated with the Phenomenon of Coronary Slow Flow in Patients with Nonvalvular Atrial Fibrillation

“…Studies have shown that patients with AF are also accompanied by altered PAI-1 levels [5]. A meta-analysis showed that elevated PAI-1 levels were associated with abnormal blood flow status in patients with AF [36]. In our study, D-Di and PAI-1 levels were significantly raised in NVAF patients combined with slow blood flow and were significantly and positively correlated with ADMA levels, which suggest that ADMA plays an important role in the regulation of abnormalities of the fibrinolytic system in patients with AF.…”

Serum fibrinogen-to-albumin ratio predicts new-onset atrial fibrillation risk during hospitalization in patients with acute myocardial infarction after percutaneous coronary intervention: a retrospective study

“…FIB was also independently associated with 2-year all-cause and cardiac mortality in patients with CAD treated with PCI [ 11 ]. In a meta-analysis of coagulation and AF, there was a significant association between FIB levels and the incidence of AF; however, other cardiovascular risk factors, such as BMI or complications, weakened this association [ 54 ]. The association between FIB levels and NOAF incidence after PCI has not been studied.…”