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. 2024 May 21;22(1):42.
doi: 10.1186/s12959-024-00610-x.

D-dimer and fibrinogen indicate ischemic risk in patients with atrial fibrillation after percutaneous coronary intervention

Diona Gjermeni #  1 , Viktoria Anfang #  1 , Sofia Szabó  1 , Hannah Vetter  1 , Ana C Venhoff  2 , Stefan Leggewie  1 , David Hesselbarth  1 , Dietmar Trenk  1 , Martin Buechsel  3 , Dirk Westermann  1 , Christoph B Olivier  4
Affiliations

D-dimer and fibrinogen indicate ischemic risk in patients with atrial fibrillation after percutaneous coronary intervention

Diona Gjermeni et al. Thromb J. .

Abstract

Background: This study aimed to evaluate the association of antiphospholipid antibodies (aPL) and conventional markers of coagulation with ischemic and bleeding risk in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).

Methods: In this prospective two-center observational cohort study, patients with AF and an indication for oral anticoagulation (OAC) were enrolled after PCI. Blood was drawn on day 1-3 after PCI. Dilute Russell's viper venom time was used to determine lupus anticoagulant (LA) in OAC-free plasma. Anti-cardiolipin (aCL) IgG, IgM, and anti-β2-Glycoprotein 1 (aβ2GP1) IgG were analyzed by enzyme-linked immunosorbent assay (ELISA). Fibrinogen (FIB), d-dimer, and prothrombin fragment 1 and 2 (PF 1 + 2) were measured in citrated plasma. The primary ischemic outcome was time to major adverse cardiovascular events (MACE; death, myocardial infarction, or stroke) assessed at 6 months. Bleeding was defined according to International Society on Thrombosis and Haemostasis.

Results: 158 patients were enrolled between May 2020 and May 2021 on day 1-3 after PCI. The median age was 78 years (interquartile range [IQR] 72-82), 111 (70%) were male, and 39 (25%) presented with acute coronary syndrome. D-dimer was elevated in 74 (47%) patients, FIB was increased in 40 (25%) and PF1 + 2 in 68 (43%) patients. 32 (20%) patients had ≥ 1 antiphospholipid antibody elevated (aPL; LA: 19 [12%], aCL: 14 [9%], aβ2GP1: 2 [1%]). The presence of aPL was neither significantly associated with MACE (HR 1.46, 95% CI [0.39-5.49], p = 0.579), nor bleeding (HR 1.07 [0.30-3.84], p = 0.917). Elevated d-dimer was significantly associated with higher risk for MACE (HR 5.06 [1.09-23.41], p = 0.038) and major bleeding (HR 7.04 [1.58-31.47], p = 0.011). Elevated D-dimer increased the predictive capacity of HAS-BLED for major bleedings (HAS-BLED: AUC 0.71 [0.60-0.83] vs. HAS-BLED + d-dimer: AUC 0.79 [0.70-0.88]; p = 0.025). Increased levels of FIB were associated with higher risk for MACE (HR 3.65 [1.11-11.96], p = 0.033).

Conclusion: Biomarkers of coagulation might be suitable to assess ischemic and bleeding risk in patients with AF following PCI.

Keywords: Antiphospholipid antibodies; Atrial fibrillation; Coagulation markers; Fibrinogen; Percutaneous coronary intervention; Prothrombin fragments 1 and 2; d-dimer.

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Conflict of interest statement

CBO received research support from Deutsche Forschungsgemeinschaft, Deutsche Herzstiftung, University of Freiburg, Else Kröner-Fresenius Stiftung, and Haemonetics; Honoraria: Bayer Vital GmbH, BMS, Böhringer Ingelheim, Daiichi Sankyo, Ferrer, Idorsia, and Janssen. DT received research funding from the German Cardiac Foundation and speakers fee and honoraria for advisory board activity from AstraZeneca, ATRIVA Therapeutics, Bayer, Daiichi Sankyo, DP-Medsystems, Ferrer and Novartis.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curve for the ischemic outcome MACE (A, C) and major ISTH bleeding (B, D) at 6 months follow up (+/- 14 days) in relation to elevated d-dimer [≥ 0.5 mg/FEU] (A, B) or fibrinogen [> 420 mg/dl] (C, D), respectively
Fig. 2
Fig. 2
Association of coagulation markers, aPL and risk scores with ischemic and bleeding outcomes. Abbreviations: MACE, major adverse cardiac events; HR, hazard ratio; PF, prothrombin factor; aPL, antiphospholipid antibodies
See this image and copyright information in PMC

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