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Anticoagulation control quality affects the D-dimer levels of atrial fibrillation patients

Yosuke Nakatani1, Koichi Mizumaki, Kunihiro Nishida

  • 1Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama, Japan.

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 22, 2011
PubMed

Insights

Anticoagulation control quality impacts atrial fibrillation (AF) patients. Poor warfarin control, indicated by low time in therapeutic range (TTR) and high INR variability, elevates D-dimer levels, suggesting increased prothrombotic state.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Anticoagulation control quality is crucial for preventing thromboembolic events in atrial fibrillation (AF) patients.
  • The precise impact of anticoagulation control quality on the prothrombotic state in AF patients remains incompletely understood.

Purpose of the Study:

  • To investigate the relationship between anticoagulation control quality metrics and D-dimer levels in AF patients treated with warfarin.
  • To determine if time in therapeutic range (TTR), percentage of INR values in range (%INR), and coefficient of variation of INR (CV-INR) correlate with markers of a prothrombotic state.

Main Methods:

  • Prospective follow-up of 95 AF patients treated with warfarin for approximately 449 days.
  • Analysis of international normalized ratio (INR) parameters: TTR, %INR, and CV-INR.
  • Measurement of D-dimer levels as a marker of the prothrombotic state.

Main Results:

  • TTR and %INR were highly correlated (R² = 0.917, P<0.01), while TTR and CV-INR showed no significant correlation (R² = 0.050, P = 0.26).
  • Mean and median D-dimer levels were 0.79 µg/ml and 0.60 µg/ml, respectively.
  • Lower TTR, lower %INR, and higher CV-INR were significantly associated with elevated D-dimer levels (P = 0.02, 0.03, and 0.02, respectively).

Conclusions:

  • In AF patients on warfarin, suboptimal anticoagulation control, characterized by both insufficient time within the therapeutic INR range and significant INR fluctuations, is linked to a heightened prothrombotic state.
  • These findings underscore the importance of maintaining stable anticoagulation control to mitigate thrombotic risk in AF patients.
Abstract

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