D-dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation - observations from the ARISTOTLE trial

被引：83

作者：

Christersson, C. ^{[1
]}

Wallentin, L. ^{[1
,2
]}

Andersson, U. ^{[2
]}

Alexander, J. H. ^{[3
]}

Ansell, J. ^{[4
]}

De Caterina, R. ^{[5
,6
]}

Gersh, B. J. ^{[7
]}

Granger, C. B. ^{[3
]}

Hanna, M. ^{[8
]}

Horowitz, J. D. ^{[9
]}

Huber, K. ^{[10
]}

Husted, S. ^{[11
]}

Hylek, E. M. ^{[12
]}

Lopes, R. D. ^{[3
]}

Siegbahn, A. ^{[1
,2
]}

机构：

[1] Uppsala Univ, Dept Med Sci, SE-75185 Uppsala, Sweden

[2] Uppsala Univ, Uppsala Clin Res Ctr UCR, SE-75185 Uppsala, Sweden

[3] Duke Univ, Med Ctr, Durham, NC USA

[4] Lenox Hill Hosp, New York, NY 10021 USA

[5] Gabriele dAnnunzio Univ, Chieti, Italy

[6] Gabriele Monasterio Fdn, Pisa, Italy

[7] Mayo Clin, Coll Med, Rochester, MN USA

[8] Bristol Myers Squibb Co, Princeton, NJ USA

[9] Univ Adelaide, Adelaide, SA, Australia

[10] Wilhelminen Hosp, Dept Internal Med Cardiol & Emergency Med, Vienna, Austria

[11] Hosp Unit West, Dept Med, Herning Holstebro, Denmark

[12] Boston Univ, Med Ctr, Boston, MA USA

来源：

JOURNAL OF THROMBOSIS AND HAEMOSTASIS | 2014年 / 12卷 / 09期

关键词：

apixaban; atrial fibrillation; D-dimer; risk assessment; warfarin; VENOUS THROMBOEMBOLISM; STRATIFICATION SCHEMES; COAGULATION ACTIVITY; STROKE; WARFARIN; APIXABAN; MARKERS; THROMBOGENESIS; ACTIVATION; BIOMARKERS;

D O I：

10.1111/jth.12638

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundD-dimer is related to adverse outcomes in arterial and venous thromboembolic diseases. ObjectivesTo evaluate the predictive value of D-dimer level for stroke, other cardiovascular events, and bleeds, in patients with atrial fibrillation (AF) treated with oral anticoagulation with apixaban or warfarin; and to evaluate the relationship between the D-dimer levels at baseline and the treatment effect of apixaban vs. warfarin. MethodsIn the ARISTOTLE trial, 18201 patients with AF were randomized to apixaban or warfarin. D-dimer was analyzed in 14878 patients at randomization. The cohort was separated into two groups; not receiving vitaminK antagonist (VKA) treatment and receiving VKA treatment at randomization. ResultsHigher D-dimer levels were associated with increased frequencies of stroke or systemic embolism (hazard ratio [HR][Q4 vs. Q1]1.72, 95% confidence interval [CI]1.14-2.59, P=0.003), death (HR[Q4 vs. Q1]4.04, 95%CI3.06-5.33) and major bleeding (HR[Q4 vs. Q1]2.47, 95%CI1.77-3.45, P<0.0001) in the no-VKA group. Similar results were obtained in the on-VKA group. Adding D-dimer level to the CHADS(2) score improved the C-index from 0.646 to 0.655 for stroke or systemic embolism, and from 0.598 to 0.662 for death, in the no-VKA group. D-dimer level improved the HAS-BLED score for prediction of major bleeds, with an increase in the C-index from 0.610 to 0.641. There were no significant interactions between efficacy and safety of study treatment and D-dimer level. ConclusionIn anticoagulated patients with AF, the level of D-dimer is related to the risk of stroke, death, and bleeding, and adds to the predictive value of clinical risk scores. The benefits of apixaban were consistent, regardless of the baseline D-dimer level.

引用

页码：1401 / 1412

页数：12

共 35 条

[1] D-Dimer and Prothrombin Fragment 1+2 Predict Venous Thromboembolism in Patients With Cancer: Results From the Vienna Cancer and Thrombosis Study [J].