Abstract Number: PB2060
Meeting: ISTH 2020 Congress
Background: Current paradigm on stroke prevention in atrial fibrillation (AF) calls for anticoagulation of all AF patients unless assumed to be at low risk of stroke, which, in routine clinical care, is assessed using the CHA2DS2-VASc score. Current guidelines do not issue a strong recommendation for use of biomarkers in risk assessment.
Aims: To investigate the association of clinical risk factors and biomarkers (troponin T, NT-proBNP, D-dimer, von Willebrand factor, and factor VIII) with the occurrence of thromboembolic events (TEE), ISTH major bleeding, and all-cause death.
Methods: We enrolled 316 patients (median age [IQR]: 72 years [65-77]; 39.6% women) with non-valvular AF into a hospital-based registry and prospectively recorded occurrence of TEE, bleeding, and all-cause death. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using the Cox-proportional hazard model.
Results: Over a median observation period of 308 days (244-560), we recorded 10 (3.3%) TEE and 11 (3.7%) bleedings. Until November 7, 2018, a total of 54 study participants (18.0%) had died from all causes. The CHA2DS2-VASc score (HR 2.99 [per 1 point increase], 95% CI 1.7-5.25) and two of its individual risk factors, female sex (HR 15.7, 95% CI 2.5-101) and history of stroke
(HR 21.0, 95% CI 3.6-123), were independently associated with increased TEE risk. None of the biomarkers were associated with risk of TEE or bleeding. NT-proBNP (HR 1.09 [per 1000 pg/mL increase], 95% CI 1.03-1.14), D-dimer (HR 1.28 [per 1 µg/mL increase], 95% CI 1.01-1.63), and age (HR 1.05 [per 1 year increase], 95% CI 1.01-1.1) were independently associated with increased risk for all-cause death.
Conclusions: In our cohort of predominately anticoagulated AF patients, history of stroke, female sex, and the CHA2DS2-VASc score were independent predictors for TEE. While no biomarker was associated with TEE or bleeding risk, NT-proBNP and D-dimer were associated with increased risk for all-cause death.
To cite this abstract in AMA style:Kraemmer D, Königsbrügge O, Nopp S, Pabinger I, Ay C. Association of Clinical Risk Factors and Biomarkers with Thromboembolism, Major Bleeding, and All-Cause Death in Patients with Atrial Fibrillation in a Tertiary Care Setting [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/association-of-clinical-risk-factors-and-biomarkers-with-thromboembolism-major-bleeding-and-all-cause-death-in-patients-with-atrial-fibrillation-in-a-tertiary-care-setting/. Accessed January 23, 2022.
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