Koretsune Yukihiro, Yamashita Takeshi, Akao Masaharu, Atarashi Hirotsugu, Ikeda Takanori, Okumura Ken, Shimizu Wataru, Suzuki Shinya, Tsutsui Hiroyuki, Toyoda Kazunori, Hirayama Atsushi, Yasaka Masahiro, Yamaguchi Takenori, Teramukai Satoshi, Kimura Tetsuya, Morishima Yoshiyuki, Takita Atsushi, Inoue Hiroshi
National Hospital Organization Osaka National Hospital, Osaka, Japan.
The Cardiovascular Research Institute, Tokyo, Japan.
JACC Asia. 2023 Aug 15;3(4):595-607. doi: 10.1016/j.jacasi.2023.06.004. eCollection 2023 Aug.
Little is known about the relationship between coagulation biomarkers and clinical outcomes in patients with atrial fibrillation (AF) treated with anticoagulants, especially direct oral anticoagulants (DOACs) and warfarin.
This subcohort study evaluated the association between coagulation biomarkers and clinical outcomes in elderly Japanese patients with nonvalvular AF using the ANAFIE (All Nippon AF In the Elderly) Registry.
Patients with a definitive diagnosis of nonvalvular AF and aged ≥75 years at enrollment were included. At enrollment, biomarker levels for D-dimer, thrombin-antithrombin complex (TAT), prothrombin fragment 1+2 (F1+2), and soluble fibrin monomer complex (SFMC), along with data on anticoagulant use, were recorded.
Of the 3,194 patients, 95.1% were using oral anticoagulants (OACs) (71.7% DOACs, 23.4% warfarin). D-dimer, TAT, and F1+2 levels, as well as the proportion of patients with a positive SFMC, were lower among those receiving OACs compared with those not receiving OACs. In the DOAC group, higher levels of D-dimer (≥1.0 μg/mL) and TAT (>3 ng/mL) were significantly associated with increased incidences of cardiovascular (CV) events (stroke, myocardial infarction, cardiac intervention, heart failure, and CV death), all-cause death, and CV death. In the warfarin group, higher levels of D-dimer were significantly associated with increased rates of all-cause death, higher levels of TAT with increased major bleeding, and positive SFMC with increased major bleeding and CV events.
Higher levels of coagulation biomarkers were associated with a higher risk of worse clinical outcomes, and the relationships between the coagulation biomarkers and outcomes differed between the DOAC and warfarin groups. (Prospective Observational Study in Late-Stage Elderly Patients with Non-Valvular Atrial Fibrillation All Nippon AF In Elderly Registry-ANAFIE Registry; UMIN000024006).
关于接受抗凝治疗的心房颤动（AF）患者凝血生物标志物与临床结局之间的关系，尤其是直接口服抗凝剂（DOACs）和华法林，人们了解甚少。
这项亚队列研究使用全日本老年房颤（ANAFIE）登记系统评估了日本老年非瓣膜性AF患者凝血生物标志物与临床结局之间的关联。
纳入确诊为非瓣膜性AF且入组时年龄≥75岁的患者。入组时，记录D-二聚体、凝血酶-抗凝血酶复合物（TAT）、凝血酶原片段1+2（F1+2）和可溶性纤维蛋白单体复合物（SFMC）的生物标志物水平，以及抗凝剂使用数据。
在3194例患者中，95.1%使用口服抗凝剂（OACs）（71.7%为DOACs，23.4%为华法林）。与未接受OACs的患者相比，接受OACs的患者D-二聚体、TAT和F1+2水平以及SFMC阳性患者的比例更低。在DOAC组中，较高水平的D-二聚体（≥1.0μg/mL）和TAT（>3ng/mL）与心血管（CV）事件（中风、心肌梗死、心脏介入、心力衰竭和CV死亡）、全因死亡和CV死亡的发生率增加显著相关。在华法林组中，较高水平的D-二聚体与全因死亡率增加显著相关，较高水平的TAT与大出血发生率增加相关，SFMC阳性与大出血和CV事件发生率增加相关。
较高水平的凝血生物标志物与较差临床结局的较高风险相关，并且凝血生物标志物与结局之间的关系在DOAC组和华法林组有所不同。（晚期老年非瓣膜性心房颤动患者的前瞻性观察研究全日本老年房颤登记系统-ANAFIE登记系统；UMIN000024006）
