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

IF 2.6 4区医学 Q2 HEMATOLOGY Thrombosis Journal Pub Date : 2024-05-21 DOI:10.1186/s12959-024-00610-x

Diona Gjermeni, Viktoria Anfang, Sofia Szabó, Hannah Vetter, Ana C Venhoff, Stefan Leggewie, David Hesselbarth, Dietmar Trenk, Martin Buechsel, Dirk Westermann, Christoph B Olivier

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Abstract

Background: This study aimed to evaluate the association of antiphospholipid antibodies (aPL) and conventional markers of coagulation with ischemic and bleeding risk in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

Methods: In this prospective two-center observational cohort study, patients with AF and an indication for oral anticoagulation (OAC) were enrolled after PCI. Blood was drawn on day 1-3 after PCI. Dilute Russell's viper venom time was used to determine lupus anticoagulant (LA) in OAC-free plasma. Anti-cardiolipin (aCL) IgG, IgM, and anti-β2-Glycoprotein 1 (aβ2GP1) IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). Fibrinogen (FIB), d-dimer, and prothrombin fragment 1 and 2 (PF 1 + 2) were measured in citrated plasma. The primary ischemic outcome was time to major adverse cardiovascular events (MACE; death, myocardial infarction, or stroke) assessed at 6 months. Bleeding was defined according to International Society on Thrombosis and Haemostasis.

Results: 158 patients were enrolled between May 2020 and May 2021 on day 1-3 after PCI. The median age was 78 years (interquartile range [IQR] 72-82), 111 (70%) were male, and 39 (25%) presented with acute coronary syndrome. D-dimer was elevated in 74 (47%) patients, FIB was increased in 40 (25%) and PF1 + 2 in 68 (43%) patients. 32 (20%) patients had ≥ 1 antiphospholipid antibody elevated (aPL; LA: 19 [12%], aCL: 14 [9%], aβ2GP1: 2 [1%]). The presence of aPL was neither significantly associated with MACE (HR 1.46, 95% CI [0.39-5.49], p = 0.579), nor bleeding (HR 1.07 [0.30-3.84], p = 0.917). Elevated d-dimer was significantly associated with higher risk for MACE (HR 5.06 [1.09-23.41], p = 0.038) and major bleeding (HR 7.04 [1.58-31.47], p = 0.011). Elevated D-dimer increased the predictive capacity of HAS-BLED for major bleedings (HAS-BLED: AUC 0.71 [0.60-0.83] vs. HAS-BLED + d-dimer: AUC 0.79 [0.70-0.88]; p = 0.025). Increased levels of FIB were associated with higher risk for MACE (HR 3.65 [1.11-11.96], p = 0.033).

Conclusion: Biomarkers of coagulation might be suitable to assess ischemic and bleeding risk in patients with AF following PCI.

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D-二聚体和纤维蛋白原显示心房颤动患者经皮冠状动脉介入治疗后的缺血风险。

研究背景本研究旨在评估抗磷脂抗体（aPL）和常规凝血标志物与接受经皮冠状动脉介入治疗（PCI）的房颤患者缺血和出血风险的关系：在这项前瞻性双中心观察性队列研究中，纳入了接受经皮冠状动脉介入治疗的心房颤动且有口服抗凝药（OAC）指征的患者。PCI术后第1-3天抽血。稀释罗素蝰蛇毒时间用于测定不含 OAC 的血浆中狼疮抗凝物 (LA)。通过酶联免疫吸附试验（ELISA）分析抗心磷脂（aCL）IgG、IgM 和抗β2-糖蛋白 1（aβ2GP1）IgG。枸橼酸血浆中的纤维蛋白原（FIB）、d-二聚体和凝血酶原片段 1 和 2（PF 1 + 2）也得到了测定。主要缺血性结局是在 6 个月时评估发生主要不良心血管事件（MACE；死亡、心肌梗死或中风）的时间。出血的定义符合国际血栓与止血学会的标准：2020年5月至2021年5月期间，PCI术后第1-3天有158名患者入组。中位年龄为 78 岁（四分位距[IQR] 72-82），111 人（70%）为男性，39 人（25%）患有急性冠脉综合征。74名（47%）患者的D-二聚体升高，40名（25%）患者的FIB升高，68名（43%）患者的PF1 + 2升高。32（20%）名患者有≥1种抗磷脂抗体升高（aPL；LA：19 [12%]，aCL：14 [9%]，aβ2GP1：2 [1%]）。aPL 的存在与 MACE（HR 1.46，95% CI [0.39-5.49]，p = 0.579）或出血（HR 1.07 [0.30-3.84]，p = 0.917）均无显著相关性。D-二聚体升高与MACE（HR 5.06 [1.09-23.41]，p = 0.038）和大出血（HR 7.04 [1.58-31.47]，p = 0.011）风险升高显著相关。D 二聚体升高增加了 HAS-BLED 对大出血的预测能力（HAS-BLED：HAS-BLED：AUC 0.71 [0.60-0.83] vs. HAS-BLED + D-二聚体：AUC 0.79 [0.70-0.88]; p = 0.025）。FIB水平升高与MACE风险升高有关（HR 3.65 [1.11-11.96]，p = 0.033）：凝血生物标志物可能适用于评估房颤患者PCI术后的缺血和出血风险。

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来源期刊

Thrombosis Journal Medicine-Hematology

CiteScore

3.80

自引率

3.20%

发文量

审稿时长

16 weeks

期刊介绍： Thrombosis Journal is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis. Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.