Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation

Christersson, Christina; Wallentin, Lars; Andersson, Ulrika; Alexander, John H.; Alings, Marco; Caterina, Raffaele De; Gersh, Bernard J.; Granger, Christopher B.; Halvorsen, Sigrun; Hanna, Michael; Huber, Kurt; Lopes, Renato D.; Oh, Byung‐Hee; Siegbahn, Agneta

doi:10.1136/heartjnl-2018-313351

Cited by 23 publications

(17 citation statements)

References 32 publications

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“…Among OACs, it is reasonable to hypothesize that using an effective anticoagulant therapeutic strategy may suppress D-dimer levels to a greater degree, which could further reduce the risk of stroke in patients with elevated D-dimer levels [7,8,11]. Previous studies reported that NOACs were more efficient in reducing D-dimer levels than warfarin [7,8]. However, no studies have investigated the efficacy of NOACs versus warfarin in patients with AF-related stroke and atherosclerotic diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we did not collect detailed information on the changes in D-dimer levels after antithrombotic treatment during follow-up. Third, D-dimer value could change over time and be affected by anticoagulation or thrombolytic therapy [7,8,11]. There are different methods and time points to measure D-dimer levels, which may lead to substantial variations in the results.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of anticoagulants for stroke prevention in AF patients could be related to the suppression of elevated D-dimer levels. Similarly, the superior ability of non-vitamin K antagonist OACs (NOACs) to further reduce elevated D-dimer levels compared to warfarin might be attributed to the relatively higher efficacy of NOACs [7,8]. However, there are no reports that have examined the effect of D-dimer levels or proper antithrombotic strategies according to baseline D-dimer levels for secondary prevention of stroke in patients with AF and atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

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Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Choi

Seo

Park

et al. 2019

JCM

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Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL) were significantly associated with higher risk of recurrent ischemic stroke (adjusted hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.13–2.84; p = 0.012). The risk of recurrent stroke was similar between the anticoagulant and the antiplatelet groups in all subjects (adjusted HR, 0.78; 95% CI, 0.46–1.32; p = 0.369). However, in patients with high D-dimer levels (≥2 μg/mL), risk of recurrent stroke was significantly lower in the anticoagulant group than in the antiplatelet group (adjusted HR, 0.40; 95% CI, 0.18–0.87; p = 0.022). Conclusion: Our findings suggested that baseline D-dimer levels could be used as a risk assessment biomarker of recurrent stroke in patients with AF-related stroke and atherosclerosis. High D-dimer levels would facilitate the identification of patients who are more likely to benefit from anticoagulants to ensure secondary prevention of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Choi

Seo

Park

et al. 2019

JCM

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“…However, HT has been underexplored in non-AF patients; the majority of AIS patients are non-AF patients [ 15 , 16 ] and they could also develop HT. Meanwhile, AF and medication for AF would influence hemostasis functions [ 17 , 18 ]. Thus, the risk factors of non-AF patients to develop HT after AIS need to be further explored, especially hemostasis functions.…”

Section: Introductionmentioning

confidence: 99%

Hemostasis functions are associated with hemorrhagic transformation in non-atrial fibrillation patients: a case-control study

et al. 2021

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Background Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop into HT. In this study, we aimed to explore whether hemostasis parameters are risk factors of HT in non-AF patients. Methods We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 h of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels. Results In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268–9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455–0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346–2.760, P < 0.001) were significantly associated with HT in non-AF patients. But in AF patients, hemostasis parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032–1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047–1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients. Conclusions Low PLT, low MPV, and high FIB levels were independently associated with HT in non-AF patients. Additionally, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that hemostasis functions at admission may be beneficial for clinicians to recognize patients with a high risk of HT at an early stage and improve unfavorable long-term outcomes in non-AF patients.

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“…However, HT has been underexplored in non-AF patients; the majority of AIS patients are non-AF patients [14,15] and they could also develop HT. Meanwhile, AF and medication for AF would in uence coagulation functions [16,17].Thus, the risk factors of non-AF patients to develop HT after AIS needs to be further explored, especially coagulation functions.…”

Section: Introductionmentioning

confidence: 99%

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

Cheng

Chen

Zeng

et al. 2020

Preprint

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Background: Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop to HT. In this study, we aimed to explore whether coagulation parameters are risk factors of HT in non-AF patients.Methods: We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 hours of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels.Results: In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268-9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455-0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346-2.760, P <0.001) were significantly associated with HT in non-AF patients. But in AF patients, coagulation parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032-1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047-1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients.Conclusions: Low PLT, low MPV and high FIB levels were independently associated with HT in non-AF patients. Additionaly, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that coagulation functions at admission may be beneficial for clinicians to recognize patients with high risk of HT at early stage and improve unfavorable long-term outcomes in non-AF patients.

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Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation

Cited by 23 publications

References 32 publications

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis

Hemostasis functions are associated with hemorrhagic transformation in non-atrial fibrillation patients: a case-control study

Coagulation Functions Are Associated With Hemorrhagic Transformation in Non-Atrial Fibrillation Patients: A Case Control Study

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