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D-dimer and fibrinogen indicate ischemic risk in patients with atrial fibrillation after percutaneous coronary

Diona Gjermeni1, Viktoria Anfang1, Sofia Szabó1

  • 1Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Thrombosis Journal
|May 21, 2024
PubMed

Insights

Antiphospholipid antibodies (aPL) did not correlate with ischemic or bleeding risks in atrial fibrillation (AF) patients post-percutaneous coronary intervention (PCI). Elevated d-dimer and fibrinogen levels, however, significantly predicted adverse cardiovascular events and bleeding risk.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI) face risks of ischemic events and bleeding.
  • Antiphospholipid antibodies (aPL) are implicated in thrombotic events, but their role in AF patients post-PCI is unclear.
  • Conventional coagulation markers may offer insights into these risks.

Purpose of the Study:

  • To investigate the association between antiphospholipid antibodies (aPL) and coagulation markers with ischemic and bleeding risks.
  • To evaluate the predictive value of these markers in AF patients after PCI.

Main Methods:

  • Prospective, two-center observational cohort study of 158 AF patients post-PCI.
  • Assessed lupus anticoagulant (LA), anti-cardiolipin (aCL), and anti-β2-Glycoprotein 1 (aβ2GP1) antibodies.
  • Measured fibrinogen (FIB), d-dimer, and prothrombin fragment 1+2 (PF1+2) levels.
  • Primary outcomes: major adverse cardiovascular events (MACE) and major bleeding at 6 months.

Main Results:

  • aPL presence was not significantly associated with MACE or bleeding.
  • Elevated d-dimer strongly predicted higher risk for MACE (HR 5.06) and major bleeding (HR 7.04).
  • Elevated d-dimer improved the predictive capacity of the HAS-BLED score for major bleeding (AUC 0.79).
  • Increased FIB levels were linked to a higher MACE risk (HR 3.65).

Conclusions:

  • Antiphospholipid antibodies (aPL) do not appear to be significant risk factors for ischemic or bleeding events in AF patients post-PCI.
  • Coagulation biomarkers, particularly d-dimer and fibrinogen, show promise in assessing thrombotic and bleeding risks in this patient population.
  • These findings suggest that conventional coagulation markers may be more clinically relevant than aPL for risk stratification in AF patients undergoing PCI.
Abstract

Keywords:
Antiphospholipid antibodiesAtrial fibrillationCoagulation markersFibrinogenPercutaneous coronary interventionProthrombin fragments 1 and 2d-dimer

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