Presentation on theme: "Evidence That D-dimer Levels Predict Subsequent Thromboembolic and Cardiovascular Events in Patients with Atrial Fibrillation during Oral Anticoagulant."— Presentation transcript:
Evidence That D-dimer Levels Predict Subsequent Thromboembolic and Cardiovascular Events in Patients with Atrial Fibrillation during Oral Anticoagulant Therapy Tsuneaki SADANAGA Ueki Hospital, Kumamoto, Japan
【 Purpose 】 Atrial fibrillation is associated with hemostatic abnormality even during oral anticoagulant therapy. Hypothesis: elevated D-dimer levels predict thromboembolic and cardiovascular events in patients with atrial fibrillation during oral anticoagulant therapy
Control 28 – 457 days ( INR 1.5-3.7) Oral anticoagulant therapy decreased D-dimer levels (30 paroxysmal Af, 13 chronic Af, n=43) p <0.01 0.5µg/ml 12/43 =28%, however… 29/43 =67% (µg/ml) D-dimer levels
【 Methods 】 Single center, prospective, observational study Patients with atrial fibrillation (269 patients, 74±9 y/o, 152 male, 157 paroxysmal, 20 prosthetic valve) receiving anticoagulant therapy with warfarin are included. Exclusion: aortic aneurysm, deep vein thrombosis, malignancy (terminal stage), non-compliance (dementia) Entry periods: January 2006 - April 2007 Observational periods: January 2006 - December 2008 Follow-up duration: 756±221 (1-1091, median: 736) days D-dimer was measured only during entry periods PT-INR was measured every 1-2 month during observational periods
End points 1.Thromboembolic events (cerebral infarction, transient ischemic attack, peripheral embolism) 2.Combined cardiovascular events (thromboembolic events, cerebral hemorrhage, myocardial infarction, cardiovascular death) Secondary analysis Bleeding complications (intracranial bleeding, gastrointestinal bleeding requiring transfusion) The study protocol was approved by the institutional Ethics Committee and informed written consent was obtained from all the patients included in this study.
6 lost to follow Follow-up 385-700 day → included in the analysis 4 discontinuation of warfarin Follow-up374-630 day → included in the analysis 1 bleeding (accidental fall) 3 physician’s decision (no recurrence of pAf) 259 (96%) completed follow-up at the end of observational periods or reached endpoints 【 Follow-up 】
【 Risk factors for thromboembolic events by Cox proportional hazard analysis 】 Univariate Analysis D-dimerp<0.01 INR<1.5 (at the time of event)p<0.01 Gender p=0.30 CHFp=0.012 Hypertensionp=0.36 Age≥75 y/op=0.36 Diabetes mellitusp=0.60 History of strokep<0.01 Multivariate Analysis Hazard ratio (95% CI) D-dimer p=0.0137.72 (1.53-38.8) History of strokep<0.015. 67 (1.57-20.4) CHF p=0.0597.66 (0.93-63.1)
【 Risk factors for bleeding complications by Cox proportional hazard analysis 】 Univariate Analysis D-dimerp<0.01 INR>3.0(at the time of bleeding)p<0.01 Gender(female)p=0.054 CHFp=0.33 Hypertensionp=0.98 Agep<0.01 Diabetes mellitusp=0.15 History of strokep<0.01 Multivariate Analysis Hazard ratio (95% CI) D-dimer p<0.01 18.1 (2.2-150) INR>3.0(at the time of bleeding)p<0.0126.4 (5.80-120) Gender(female)p=0.01210.8 (1.69-68) History of strokep=0.0136.84 (1.51-31.1)
【 Conclusion 】 Persistent elevation of D-dimer Levels despite proper anticoagulant therapy can predict thromboembolic and cardiovascular events in patients with atrial fibrillation Further larger scale, multicenter studies are needed to confirm these findings.