D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients: a systematic review and metanalysis

Biccirè, Flavio Giuseppe; Farcomeni, Alessio; Gaudio, Carlo; Pignatelli, Pasquale; Tanzilli, Gaetano; Pastori, Daniele

doi:10.1186/s12959-021-00354-y

Cited by 15 publications

(17 citation statements)

References 76 publications

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“…neutrophils to lymphocytes ratio and D-Dimer, all biomarkers associated with poor prognosis in ACS setting[15][16][17][18][19]. Then, in our population, MI clinical presentation was worse in LF patients.…”

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confidence: 61%

Relationship between non-invasively detected liver fibrosis and in-hospital outcomes in patients with acute coronary syndrome undergoing PCI

et al. 2022

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Background Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) still experience a high rate of in-hospital complications. Liver fibrosis (LF) is a risk factor for mortality in the general population. We investigated whether the presence of LF detected by the validated fibrosis 4 (FIB-4) score may indicate ACS patients at higher risk of poor outcome. Methods In the prospective ongoing REAl-world observationaL rEgistry of Acute Coronary Syndrome (REALE-ACS), LF was defined by a FIB-4 score > 3.25. We repeated the analysis using an APRI score > 0.7. The primary endpoint was in-hospital adverse events (AEs) including a composite of in-hospital cardiogenic shock, PEA/asystole, acute pulmonary edema and death. Results A total of 469 consecutive ACS consecutive patients were enrolled. Overall, 21.1% of patients had a FIB-4 score > 3.25. Patients with LF were older, less frequently on P2Y12 inhibitors (p = 0.021) and admitted with higher serum levels of white blood cells (p < 0.001), neutrophils to lymphocytes ratio (p < 0.001), C-reactive protein (p = 0.013), hs-TnT (p < 0.001), creatine-kinase MB (p < 0.001), D-Dimer levels (p < 0.001). STEMI presentation and higher Killip class/GRACE score were more common in the LF group (p < 0.001). 71 patients experienced 110 AEs. At the multivariate analysis including clinical and laboratory risk factors, FIB-4 > 3.25 (OR 3.1, 95%CI 1.4–6.9), admission left ventricular ejection fraction% below median (OR 9.2, 95%CI 3.9–21.7) and Killip class ≥ II (OR 6.3, 95%CI 2.2–18.4) were the strongest independent predictors of in-hospital AEs. Similar results were obtained using the APRI score. Conclusion LF detected by FIB-4 score > 3.25 was associated with more severe ACS presentation and worse in-hospital AEs irrespective of clinical and laboratory variables. Graphical abstract

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confidence: 61%

Relationship between non-invasively detected liver fibrosis and in-hospital outcomes in patients with acute coronary syndrome undergoing PCI

et al. 2022

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“…Thrombus burden, as measured by circulating D-dimer levels, has been associated with the risk of cardiovascular events, such as myocardial infarction, in a number of populations such as patients with acute coronary syndrome [ 18 ]. A previous study of 98 patients with unrepaired AAA examined by computed tomography reported that participants with AAA thrombus volume above median had an increased risk of cardiovascular events (relative risk 2.8, 95% CI 1.01, 5.24) [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Oral Anticoagulation Prescription with Clinical Events in Patients with an Asymptomatic Unrepaired Abdominal Aortic Aneurysm

et al. 2022

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Background: Most abdominal aortic aneurysms (AAA) have large volumes of intraluminal thrombus which has been implicated in promoting the risk of major adverse events. The aim of this study was to examine the association of therapeutic anticoagulation with AAA-related events and major adverse cardiovascular events (MACE) in patients with an unrepaired AAA. Methods: Patients with an asymptomatic unrepaired AAA were recruited from four sites in Australia. The primary outcome was the combined incidence of AAA repair or AAA rupture-related mortality (AAA-related events). The main secondary outcome was MACE (the combined incidence of myocardial infarction, stroke, or cardiovascular death). The associations of anticoagulation with these outcomes were assessed using Cox proportional hazard analyses (reporting hazard ratio, HR, and 95% confidence intervals, CI) to adjust for other risk factors. Results: A total of 1161 patients were followed for a mean (standard deviation) of 4.9 (4.0) years. Of them, 536 (46.2%) patients had a least one AAA-related event and 319 (27.5%) at least one MACE. In the sample, 98 (8.4%) patients were receiving long-term therapeutic anticoagulation using warfarin (84), apixaban (7), rivaroxaban (6), or dabigatran (1). Prescription of an anticoagulant was associated with a reduced risk of an AAA-related event (adjusted HR 0.61; 95% CI 0.42, 0.90, p = 0.013), but not MACE (HR 1.16; 95% CI 0.78, 1.72, p = 0.476). Conclusions: These findings suggest that AAA-related events but not MACE may be reduced in patients prescribed an anticoagulant medication. Due to the inherent biases of observational studies, a randomized controlled trial is needed to assess whether anticoagulation reduces the risk of AAA-related events.

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“…Several biomarkers play an important role in the risk stratification for recurrent cardiovascular risk in patients with ACS. Biomarkers representing the pathophysiological processes of hemodynamic stress [N-terminal pro-B-type natriuretic peptide (NT-proBNP)] ( 10 ), inflammation [high-sensitivity C-reactive protein (hs-CRP) and fibrinogen] ( 11 , 12 ), activated coagulation (D-dimer) ( 13 ), endothelial activation [uric acid(UA)] ( 14 ), oxidative stress [gamma-glutamyl transferase (GGT)] ( 15 ), as well as lipid disorders[lipoprotein(a) [Lp(a)]] ( 16 ) have been shown to be associated with increased cardiovascular risk in patients with ACS. Moreover, a simultaneous multimarker strategy improved risk stratification compared to the use of individual biomarkers alone in patients with ACS ( 17 – 20 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic performance of multiple biomarkers in patients with acute coronary syndrome without standard cardiovascular risk factors

Wang

Cong

Zhang

et al. 2022

Front. Cardiovasc. Med.

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Background and aimsAcute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRFs) represents a special case of ACS. Multiple biomarkers have been shown to improve risk stratification in patients with ACS. However, the utility of biomarkers for prognostic stratification in patients with ACS without SMuRFs remains uncertain. The aim of the present study was to evaluate the prognostic value of various biomarkers in patents with ACS without SMuRFs.MethodsData of consecutive patients with ACS without SMuRFs who underwent coronary angiography in Tianjin Chest Hospital between January 2014 and December 2017 were retrospectively collected. The primary outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, myocardial infarction and stroke. Seven candidate biomarkers analyses were analyzed using models adjusted for established risk factors.ResultsDuring a median 5-year follow-up, 81 of the 621 patients experienced a MACE. After adjustment for important covariates, elevated fibrinogen, D-dimer, N-terminal proB-type natriuretic peptide (NT-proBNP), and lipoprotein (a) [Lp(a)] were found to be individually associated with MACE. However, only D-dimer, NT-proBNP and Lp(a) significantly improved risk reclassification for MACE (all P < 0.05). The multimarker analysis showed that there was a clear increase in the risk of MACE with an increasing number of elevated biomarkers and a higher multimarker score. The adjusted hazard ratio- for MACE (95% confidential intervals) for patients with 4 elevated biomarkers was 6.008 (1.9650–18.367) relative to those without any elevated biomarker-. Adding- the 4 biomarkers or the multimarker score to the basic model significantly improved the C-statistic value, the net reclassification index and the integrated discrimination index (all P < 0.05).ConclusionFibrinogen, D-dimer, NT-proBNP and Lp(a) provided valuable prognostic information for MACE when applied to patients with ACS without SMuRFs. The multimarker strategy, which combined multiple biomarkers reflecting different pathophysiological process with traditional risk factors improved the cardiovascular risk stratification.

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D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients: a systematic review and metanalysis

Cited by 15 publications

References 76 publications

Relationship between non-invasively detected liver fibrosis and in-hospital outcomes in patients with acute coronary syndrome undergoing PCI

Relationship between non-invasively detected liver fibrosis and in-hospital outcomes in patients with acute coronary syndrome undergoing PCI

Association of Oral Anticoagulation Prescription with Clinical Events in Patients with an Asymptomatic Unrepaired Abdominal Aortic Aneurysm

Prognostic performance of multiple biomarkers in patients with acute coronary syndrome without standard cardiovascular risk factors

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