Aging　– The Great Impact on Coagulation State –

Abstract

2092TAKAHASHI N Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp those aged 65-74 years is not so high, but for those aged ≥75 years it is remarkably high. In this issue of the Journal, Ochi et al 7 report on their study in which they measured plasma levels of D-dimer, prothrombin-fragment1+2 (F1+2), plasmin-α2 plasmin inhibitor complex (PIC), and thrombomodulin (TM) in "real-world" cardiology outpatients. D-dimer is a byproduct of the degradation of fibrin, reflecting thrombin and fibrin turnover, and is a surrogate marker for a hypercoagulable state. F1+2, which arises from in vivo cleavage of prothrombin by factor Xa, is considered to be useful for diagnosis of thrombosis. PIC is a fibrinolytic marker that directly reflects the generation of plasmin in vivo. Soluble TM is considered to be a marker of plasma endothelial damage or dysfunction marker. Ochi et al 7 demonstrate a significant correlation between aging and the levels of F1+2, D-dimer, and PIC. In contrast, there were no sex-associated differences in these markers of coagulation and fibrinolysis. When examining the determinants of high F1+2 isk stratification for stroke and thromboembolism in patients with non-valvular atrial fibrillation (NVAF) is very important to identify those patients requiring oral anticoagulation therapy. The simplest risk assessment scheme is the CHADS2 score. The CHA2DS2-VASc score is inclusive of the most common stroke risk factors in everyday clinical practice. The characteristics of the CHA2DS2-VASc score, compared with the CHADS2 score, is that either age 65-74 or female sex is counted as 1 point risk. Age ≥75 is doubly counted as 2 points. In fact, the ESC guideline proposed that previous stroke, transient ischemic attack (TIA) or systemic embolism, and age ≥75 should be regarded as "major" risk factors, while the other 6 are "clinically relevant non-major" risk factors. 2 Here, I would like to discuss the impact of aging and sex category in Japanese NVAF patients. Article p 2133In the J-RHYTHM Registry, consecutive patients with AF were recruited from the outpatient clinic of each participating institution from January 2009 to July 2009. 3 A total of 7,937 patients with AF (mean age, 70 years) were enrolled. Subanalysis of the J-RHYTHM Registry has demonstrated that female sex is not a risk factor for thromboembolic events in those who were treated mostly with warfarin. 4 Subsequently, the validity of risk scoring systems excluding female sex from CHA2DS2-VASc was reported. 5 What about aging? Suzuki et al 6 performed a pooled analysis of 3,588 patients from the Shinken Database, J-RHYTHM Registry, and Fushimi AF Registry to determine the incidence rate of ischemic stroke in Japanese NVAF patients without anticoagulation therapy. Their analysis revealed that the incidence of ischemic stroke increased with age from 6.9 per 1,000 person-years in patients aged <65 years to 9.8 per 1,000 person-years in those aged 65-74 years and 24.5 per 1,000 person-years in those aged ≥75...