Abstract Number: PB0017
Meeting: ISTH 2021 Congress
Background: Atrial fibrillation in patients on hemodialysis (HD) is associated with an increased risk of stroke, transient ischemic attack (TIA) and systemic embolism (SE). Identification of patients at high risk would be of clinical relevance in order to personalize anticoagulation. Soluble P-selectin (sP-selectin) is a marker of platelet activation and is associated with a prothrombotic state in AF patients in the general population.
Aims: We aimed to investigate the association between sP-selectin and the occurrence of thromboembolic outcomes.
Methods: In a cohort study of end-stage renal failure patients on HD, we measured plasma levels of sP-selectin using an enzyme-linked immunoassay (R&D Systems, Minneapolis, USA). Occurrence of ischemic stroke, TIA, SE, and major bleeding were recorded over a maximum observation period of 45 months (median 29 months). Risk of outcome occurrence was calculated with risk regression considering for the competing risk of death and AF as a time-dependent variable.
Results: Of 595 patients, 28 patients had stroke, 7 TIA and 5 SE. In AF patients (224 patients, 76 women [33.9%], median age 71 years) levels of sP-selectin were not significantly increased compared to non-AF patients (39.9 vs 39.2 ng/ml, p=0.64), and sP-selectin levels were not significantly lower in patients treated with anticoagulants (38.0 vs 39.8 ng/ml, p=0.30) or anti-platelet agents (39.2 vs 39.7 ng/ml, p=0.72) compared to those without anti-thrombotic agents.
In AF patients, sP-selectin was associated with a 1.8-fold increased risk for occurrence of the composite thromboembolic endpoint (stroke, TIA, SE) (SHR 1.81 per double increase, 95%CI 1.01 – 3.25, p=0.045) adjusted for age, sex, diabetes, prior stroke, prior cardiovascular disease and antiplatelet comedication, but not with occurrence of major bleeding (SHR 0.70 per double increase, 95%CI 0.34 – 1.43, p=0.325).
Conclusions: Increasing sP-selectin levels predict the risk of thromboembolic complications such as stroke, TIA, and SE in hemodialysis patients with AF.
To cite this abstract in AMA style:Koenigsbruegge O, Schmaldienst S, Lorenz M, Klauser-Braun R, Pabinger I, Säemann M, Ay C. Soluble P-selectin is Associated with Increased Risk of Ischemic Stroke in Patients with Atrial Fibrillation on Hemodialysis: Results from the VIVALDI Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/soluble-p-selectin-is-associated-with-increased-risk-of-ischemic-stroke-in-patients-with-atrial-fibrillation-on-hemodialysis-results-from-the-vivaldi-study/. Accessed October 20, 2021.
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