Xiong Yurong, Zhou Wei, Li Minghui, Wang Tao, Huang Xiao, Bao Huihui, Cheng Xiaoshu
Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
Cardiovasc Diagn Ther. 2020 Oct;10(5):1175-1183. doi: 10.21037/cdt-20-645.
A reduction in platelet count or function can be a risk factor for bleeding in anticoagulated patients. However, the association between platelet count and the risk of bleeding among nonvalvular atrial fibrillation (NVAF) patients taking dabigatran remains unclear. The aim of this study was to investigate the relationship between platelet count and the risk of bleeding among patients with NVAF taking dabigatran after radiofrequency ablation.
In this multicenter, prospective and observational study, a total of 576 NVAF patients treated with dabigatran (110 mg bid) after radiofrequency ablation were recruited from 12 centers in China from February 2015 to December 2017. All patients were followed for 3 months. The association between platelet count and the risk of bleeding was evaluated by Cox proportional hazards regression analysis. To explore the nonlinearity between platelet count and bleeding, we used a Cox proportional hazards regression model with cubic spline functions and smooth curve fitting and a two-piecewise Cox proportional hazards model.
During a median follow-up duration of 87 days, 50 patients experienced bleeding events. Overall, there was an inverse relationship between the risk of bleeding and platelet count. Low platelet count (<100×10/L) were associated with an increased risk of bleeding [hazard ratio (HR), 4.05; 95% confidence interval (CI): 1.32-12.46] compared to normal counts. The adjusted smooth curve showed a nonlinear relationship between platelet count and bleeding events. The inflection point of the platelet count was 105×10/L. For platelet counts <105×10/L, the HR (95% CI) was 0.89 (0.84-0.95), and for platelet counts ≥105×10/L, the HR (95% CI) was 1.01 (0.95-1.08).
Low platelet counts were associated with an increased risk for bleeding among patients with NVAF taking dabigatran after catheter ablation.
血小板计数或功能降低可能是抗凝患者出血的危险因素。然而，在服用达比加群的非瓣膜性心房颤动（NVAF）患者中，血小板计数与出血风险之间的关联尚不清楚。本研究的目的是探讨射频消融术后服用达比加群的NVAF患者血小板计数与出血风险之间的关系。
在这项多中心、前瞻性观察研究中，2015年2月至2017年12月期间，从中国12个中心招募了576例射频消融术后服用达比加群（110mg，每日两次）的NVAF患者。所有患者随访3个月。通过Cox比例风险回归分析评估血小板计数与出血风险之间的关联。为了探讨血小板计数与出血之间的非线性关系，我们使用了具有三次样条函数和平滑曲线拟合的Cox比例风险回归模型以及两段式Cox比例风险模型。
在中位随访期87天内，50例患者发生出血事件。总体而言，出血风险与血小板计数呈负相关。与正常计数相比，低血小板计数（<100×10⁹/L）与出血风险增加相关[风险比（HR），4.05；95%置信区间（CI）：1.32 - 12.46]。调整后的平滑曲线显示血小板计数与出血事件之间存在非线性关系。血小板计数的拐点为105×10⁹/L。对于血小板计数<105×10⁹/L，HR（95%CI）为0.89（0.84 - 0.95），对于血小板计数≥105×10⁹/L，HR（95%CI）为1.01（0.95 - 1.08）。
导管消融术后服用达比加群的NVAF患者中，低血小板计数与出血风险增加相关。
