Role of Red Cell Distribution Width in the Relationship between Clinical Outcomes and Anticoagulation Response in Patients with Atrial Fibrillation

Abstract

Little is known as to why elevated red cell distribution width (RDW) is associated with adverse clinical outcomes in patients with atrial fibrillation (AF). We hypothesized that RDW value might predict the intensity of anticoagulation, resulting in higher adverse events in patients with AF taking warfarin. We analyzed 657 patients with non-valuvular AF who took warfarin. The intensity of anticoagulation was assessed as mean time in the therapeutic range (TTR) and defined TTR ≥60% as an optimal intensity. The primary end-point was the composite of stroke/systemic embolism and major bleeding. The secondary end-point was the composite of stroke/systemic embolism, major bleeding and death. The relationship between the baseline RDW with TTR and clinical outcomes was assessed using categorical variables as quartiles or dichotomous variables. The mean value of TTR decreased as an increment of the RDW (45.2% vs. 44.7% vs. 40.8% vs. 35.2%, p<0.001). Primary and secondary end-points were significantly increased when TTR was less than 60% and RDW was more than 13.6%. Ratio of patients achieving optimal anticoagulation were significantly decreased as an increment of RDW. A RDW of ≥13.6% was a significant predictor for poor anticoagulation control (adjusted Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23–0.82), stroke (adjusted hazard ratio [HR] 3.86, 95% CI 1.11–13.40), primary (adjusted HR 1.88, 95% CI 1.12–3.16) and secondary end-point (adjusted HR 2.46, 95% CI 1.26–4.81). RDW was negatively associated with TTR in patients with AF. Therefore, RDW might be a useful marker for the prediction of anticoagulation response and clinical outcomes in patients with AF.

Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching

“…In addition, the results suggested that there were significant differences of BMI and smoker among different RDW subgroups [ 39 ]. Elevated RDW was also used as a predictor of poor prognosis of anticoagulation response in patients with AF and the impatient adults with SARS-CoV-2 infection [ 40 , 41 ]. In a previous study, adjusted OR value of metabolic syndrome was lower at the third and fourth quartile of RDW in males, and RDW might play a mediatory role in the relationship between waist circumference and the dysmetabolic outcomes in obese people [ 42 ].…”

Acute Myocardial Infarction (AMI) as the Effect Modifiers to Modify the Association Between Red Blood Cell Distribution Width (RDW) and Mortality in Critically Ill Patients With Stroke

“…Thirdly, higher RDW may reduce blood oxygen saturation, thereby reducing physiological reserves to resist hypoxic stress ( 38 ). In addition, it may cause abnormal blood coagulation and increase the risk of thromboembolism ( 39 ), and finally lead to stroke recurrence, which may exacerbate brain damage or lead to a worse prognosis. In view of the predictive role of RDW in many other diseases, RDW is more likely to be a general marker rather than a specific predictor of stroke ( 6 ).…”

Red blood cell distribution width predicts in-hospital mortality in patients with a primary diagnosis of seizures in the ICU: a retrospective database study

“…Furthermore, oxidative stress is associated with all causes of mortality among elderly people [41]. Third, patients with high RDW are more likely to have abnormal coagulation, which may lead to more severe brain damage and ultimately to poorer outcomes [42].…”