Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant.
Administration, Oral
Aged
Antithrombins
/ administration & dosage
Atrial Fibrillation
/ blood
Biomarkers
/ blood
Dabigatran
/ administration & dosage
Factor Xa Inhibitors
/ administration & dosage
Female
Fibrin Fibrinogen Degradation Products
/ metabolism
Humans
Male
Middle Aged
Prospective Studies
Pyrazoles
/ administration & dosage
Pyridines
/ administration & dosage
Pyridones
/ administration & dosage
Thiazoles
/ administration & dosage
Treatment Outcome
Atrial fibrillation
D-dimer
Direct oral anticoagulants
Left atrium
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
09 10 2021
09 10 2021
Historique:
received:
01
08
2021
accepted:
27
09
2021
entrez:
10
10
2021
pubmed:
11
10
2021
medline:
19
1
2022
Statut:
epublish
Résumé
Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation. We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters. After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003-1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910-0.986; P = 0.008) were potential predictors of high LA D-dimer levels. In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF.
Sections du résumé
BACKGROUND
Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation.
METHODS
We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters.
RESULTS
After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003-1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910-0.986; P = 0.008) were potential predictors of high LA D-dimer levels.
CONCLUSIONS
In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF.
Identifiants
pubmed: 34627142
doi: 10.1186/s12872-021-02285-y
pii: 10.1186/s12872-021-02285-y
pmc: PMC8502280
doi:
Substances chimiques
Antithrombins
0
Biomarkers
0
Factor Xa Inhibitors
0
Fibrin Fibrinogen Degradation Products
0
Pyrazoles
0
Pyridines
0
Pyridones
0
Thiazoles
0
fibrin fragment D
0
apixaban
3Z9Y7UWC1J
Dabigatran
I0VM4M70GC
edoxaban
NDU3J18APO
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
487Informations de copyright
© 2021. The Author(s).
Références
Cerebrovasc Dis. 2013;35(1):64-72
pubmed: 23428999
Ann Med. 2014 Sep;46(6):364-71
pubmed: 24863960
Diagnostics (Basel). 2020 Mar 02;10(3):
pubmed: 32131455
Stroke. 2012 May;43(5):1206-11
pubmed: 22382157
Med Sci Monit Basic Res. 2017 Mar 31;23:97-140
pubmed: 28360407
Circ J. 2015;79(1):61-9
pubmed: 25391906
Int J Cardiol. 2010 Jun 25;142(1):22-8
pubmed: 19178964
Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619847524
pubmed: 31088146
J Thromb Thrombolysis. 2013 Aug;36(2):133-40
pubmed: 23645472
J Thromb Thrombolysis. 2010 Nov;30(4):459-71
pubmed: 20213258
Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619885188
pubmed: 31718263
PLoS One. 2014 Jun 09;9(6):e99276
pubmed: 24911432
Clin Cardiol. 2021 Jan;44(1):9-10
pubmed: 33180960
N Engl J Med. 2011 Sep 15;365(11):981-92
pubmed: 21870978
Cardiovasc Ther. 2020 Apr 24;2020:3501749
pubmed: 32411299
N Engl J Med. 2013 Nov 28;369(22):2093-104
pubmed: 24251359
Chest. 2017 Jan;151(1):127-138
pubmed: 27637548
BMJ. 2017 Nov 28;359:j5058
pubmed: 29183961
J Cardiovasc Electrophysiol. 2013 May;24(5):485-91
pubmed: 23373748
N Engl J Med. 2004 Dec 2;351(23):2373-83
pubmed: 15575053
Intern Med. 2017;56(15):1977-1980
pubmed: 28768967
J Am Coll Cardiol. 1992 Mar 15;19(4):851-5
pubmed: 1545081
N Engl J Med. 2009 Sep 17;361(12):1139-51
pubmed: 19717844
Am J Cardiol. 2011 Feb 1;107(3):417-22
pubmed: 21257008