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Published on: February 26, 2013
Coagulation Biomarkers and Clinical Outcomes in Elderly Patients With Nonvalvular Atrial Fibrillation: ANAFIE
Yukihiro Koretsune1, Takeshi Yamashita2, Masaharu Akao3
1National Hospital Organization Osaka National Hospital, Osaka, Japan.
Insights
Coagulation biomarkers like D-dimer and TAT indicate higher risks for cardiovascular events and death in elderly atrial fibrillation patients on anticoagulants. Their predictive value differs between direct oral anticoagulants (DOACs) and warfarin.
Area of Science:
- Cardiology
- Hematology
- Clinical Biomarkers
Background:
- Limited understanding of coagulation biomarkers and clinical outcomes in atrial fibrillation (AF) patients on anticoagulants, particularly direct oral anticoagulants (DOACs) and warfarin.
- Investigating these relationships is crucial for optimizing anticoagulation therapy and patient management.
Purpose of the Study:
- To evaluate the association between coagulation biomarkers (D-dimer, TAT, F1+2, SFMC) and clinical outcomes in elderly Japanese patients with nonvalvular AF.
- To compare these associations between patients treated with DOACs and warfarin.
Main Methods:
- Subcohort study using the ANAFIE Registry, including nonvalvular AF patients aged ≥75 years.
- Collected data on D-dimer, thrombin-antithrombin complex (TAT), prothrombin fragment 1+2 (F1+2), soluble fibrin monomer complex (SFMC) levels, and anticoagulant use at enrollment.
- Followed patients to assess cardiovascular events, all-cause death, and major bleeding.
Main Results:
- 95.1% of 3,194 patients used oral anticoagulants (71.7% DOACs, 23.4% warfarin).
- Higher D-dimer and TAT levels were significantly associated with increased cardiovascular events, all-cause death, and CV death in the DOAC group.
- In the warfarin group, higher D-dimer correlated with all-cause death, TAT with major bleeding, and SFMC with major bleeding and CV events.
Conclusions:
- Elevated coagulation biomarkers are linked to poorer clinical outcomes in elderly AF patients.
- The predictive value of these biomarkers for specific outcomes varies between DOAC and warfarin treatments.
- These findings highlight the importance of monitoring coagulation status in AF patients receiving anticoagulation.
Background:
Little is known about the relationship between coagulation biomarkers and clinical outcomes in patients with atrial fibrillation (AF) treated with anticoagulants, especially direct oral anticoagulants (DOACs) and warfarin.
Objectives:
This subcohort study evaluated the association between coagulation biomarkers and clinical outcomes in elderly Japanese patients with nonvalvular AF using the ANAFIE (All Nippon AF In the Elderly) Registry.
Methods:
Patients with a definitive diagnosis of nonvalvular AF and aged ≥75 years at enrollment were included. At enrollment, biomarker levels for D-dimer, thrombin-antithrombin complex (TAT), prothrombin fragment 1+2 (F1+2), and soluble fibrin monomer complex (SFMC), along with data on anticoagulant use, were recorded.
Results:
Of the 3,194 patients, 95.1% were using oral anticoagulants (OACs) (71.7% DOACs, 23.4% warfarin). D-dimer, TAT, and F1+2 levels, as well as the proportion of patients with a positive SFMC, were lower among those receiving OACs compared with those not receiving OACs. In the DOAC group, higher levels of D-dimer (≥1.0 μg/mL) and TAT (>3 ng/mL) were significantly associated with increased incidences of cardiovascular (CV) events (stroke, myocardial infarction, cardiac intervention, heart failure, and CV death), all-cause death, and CV death. In the warfarin group, higher levels of D-dimer were significantly associated with increased rates of all-cause death, higher levels of TAT with increased major bleeding, and positive SFMC with increased major bleeding and CV events.
Conclusions:
Higher levels of coagulation biomarkers were associated with a higher risk of worse clinical outcomes, and the relationships between the coagulation biomarkers and outcomes differed between the DOAC and warfarin groups. (Prospective Observational Study in Late-Stage Elderly Patients with Non-Valvular Atrial Fibrillation All Nippon AF In Elderly Registry-ANAFIE Registry; UMIN000024006).
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