Division of Cardiology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan.
BMC Cardiovasc Disord. 2021 Oct 9;21(1):487. doi: 10.1186/s12872-021-02285-y.
Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation.
We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters.
After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003-1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910-0.986; P = 0.008) were potential predictors of high LA D-dimer levels.
In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF.
心房颤动（AF）可导致脑卒中和全身性栓塞。D-二聚体水平升高表明继发性纤维蛋白溶解的过度激活，导致血栓形成的倾向。为了阐明抗凝治疗的差异影响，我们比较了拟行消融术的心房颤动患者外周血和左心房（LA）血中的 D-二聚体水平。
我们分析了 141 例非瓣膜性 AF 患者（达比加群，n=30；阿哌沙班，n=47；依度沙班，n=64；平均年龄：68 岁，男性：60%）。在肺静脉隔离前采集外周静脉血和 LA 血。我们检查了实验室和超声心动图参数。
调整基线特征后，依度沙班治疗患者的 LA 中 D-二聚体水平明显高于阿哌沙班治疗患者（0.77±0.05 与 0.60±0.05μg/mL，P=0.047），尽管外周 D-二聚体水平无显著差异。我们将 LA 中的 D-二聚体值分为正常组（<0.9）和高值组（≥1.0）；外周凝血酶原片段 F1+2 水平（比值比[OR]1.012；95%置信区间[CI]：1.003-1.022；P=0.008）和左心室射血分数（LVEF）（OR，0.947；95%CI，0.910-0.986；P=0.008）是 LA 高 D-二聚体水平的潜在预测因素。
在消融日接受阿哌沙班治疗的患者中，LA 中的 D-二聚体水平低于接受依度沙班治疗的患者，提示 AF 患者中阿哌沙班对左心房的抗凝作用优于依度沙班。
