Zhang Qing, Qin Yao, Zhao Dong-Sheng, Zhao Hai-Ping, Zhou Lei
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Cardiology. 2017;136(4):215-221. doi: 10.1159/000449461. Epub 2016 Nov 2.
Recent research has indicated that red blood cell distribution width (RDW) is associated with the prognosis of cardiovascular diseases such as chronic heart failure and coronary heart disease. We aimed to study the predictive value of RDW for bleeding events in patients with nonvalvular atrial fibrillation (NVAF) during the administration of 110 mg of dabigatran twice a day after catheter ablation.
One hundred and seventy-two NVAF patients who were hospitalized and received catheter ablation in Jiangsu Provincial People's Hospital from January 2014 to January 2015 were enrolled (110 mg of dabigatran was administered orally to outpatients preoperatively twice a day for 3 weeks). The enrolled patients were divided into the high RDW (>12.8%) group (n = 85) and the low RDW (≤12.8%) group (n = 87) according to the median RDW. The activated partial thromboplastin time (APTT) at dabigatran trough concentration was also detected. Patients were followed up for 3 months to observe the occurrence of bleeding events, and the predictive value of RDW as well as APTT for bleeding events was assessed from receiver-operating characteristic (ROC) analyses.
In all patients, preoperatively, no bleeding events were observed and the APTT did not exceed twice the normal upper limit. Thirteen cases of bleeding events, all minor bleeding, occurred after a 3-month follow-up: 3 of gingival bleeding, 3 of urinary tract bleeding, 3 conjunctival hemorrhages and 4 subcutaneous hemorrhages. The incidence of bleeding events in the low RDW group was lower than in the high RDW group (3.4 vs. 11.8%, p = 0.039). The areas under the ROC curve for RDW and APTT to predict the occurrence of bleeding events were 0.737 (cutoff point 13.25%; p < 0.05) and 0.558 (p > 0.05), respectively.
RDW was associated with the occurrence of bleeding events in NVAF patients on dabigatran (110 mg twice a day) after ablation, while also being an independent predictor of bleeding events. RDW had superior predictive value for bleeding events over APTT when APTT did not exceed twice the normal upper limit.
近期研究表明，红细胞分布宽度（RDW）与慢性心力衰竭和冠心病等心血管疾病的预后相关。我们旨在研究RDW对非瓣膜性心房颤动（NVAF）患者在导管消融术后每天两次服用110mg达比加群期间出血事件的预测价值。
纳入2014年1月至2015年1月在江苏省人民医院住院并接受导管消融的172例NVAF患者（术前门诊患者口服110mg达比加群，每天两次，共3周）。根据RDW中位数将纳入患者分为高RDW（>12.8%）组（n = 85）和低RDW（≤12.8%）组（n = 87）。同时检测达比加群谷浓度时的活化部分凝血活酶时间（APTT）。对患者进行3个月随访，观察出血事件的发生情况，并通过受试者工作特征（ROC）分析评估RDW以及APTT对出血事件的预测价值。
所有患者术前均未观察到出血事件，且APTT未超过正常上限的两倍。3个月随访后发生13例出血事件，均为轻微出血：牙龈出血3例、尿路出血3例、结膜出血3例和皮下出血4例。低RDW组出血事件发生率低于高RDW组（3.4%对11.8%，p = 0.039）。RDW和APTT预测出血事件发生的ROC曲线下面积分别为0.737（截断点13.25%；p < 0.05）和0.558（p > 0.05）。
RDW与消融术后服用达比加群（每天两次，每次110mg）的NVAF患者出血事件的发生相关，同时也是出血事件的独立预测因子。当APTT未超过正常上限两倍时，RDW对出血事件的预测价值优于APTT。
