#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Thrombocytopenia and thrombocytosis are associated with different outcome in atrial fibrillation patients on anticoagulant therapy


Autoři: Yoav Michowitz aff001;  Robert Klempfner aff002;  Nir Shlomo aff002;  Ilan Goldenberg aff004;  Maya Koren-Michowitz aff002
Působiště autorů: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel aff001;  Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel aff002;  Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel aff003;  Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America aff004;  Department of Hematology, Shamir Medical Center (Asaf Harofeh), Zerifin, Israel aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224709

Souhrn

Background

Information regarding the significance of platelet (PLT) count on outcome of atrial fibrillation (AF) patients who are treated with anticoagulants is limited.

Methods

We conducted a monocentric observational retrospective cohort study of AF patients treated with either warfarin (n = 6287) or non-vitamin K antagonist oral anticoagulants (NOACs) (n = 5240). Patient were divided into 3 subgroups; low, normal and high PLT for counts < 150 K/ μl, 150–450 K/ μl and > 450 K/ μl, respectively. A multivariate Cox-regression was used to evaluate the association between PLT subgroups and clinical outcomes.

Results

During follow-up [median = 40.6 months (IQR 17.6–60)], mortality (HR 1.36, 95 CI 1.1–1.74, p = 0.01) and rate of myocardial infarction (MI) (HR 2.4, 95 CI 1.28–4.57, p = 0.007) were higher in patients with high compared to normal PLT. Transient ischemic attack or cerebrovascular accident (TIA/CVA) rate was lower in patients with low compared to normal PLT (HR 0.69, 95 CI 0.51–0.93, p = 0.02). A comparison between NOACs and warfarin demonstrated a significantly better clinical outcome for patients on NOACs in both the low (lower mortality rates) and normal PLT subgroup (lower mortality, TIA/CVA and systemic emboli rates). For patients on NOACs, low and high compared to normal PLT were associated with a higher combined outcome (HR 1.12, 95 CI 1–1.38, p = 0.047), and a higher systemic emboli rate (HR 7.07, 95 CI 1.66–30.25, p = 0.008), respectively.

Conclusions

Abnormal PLT count is associated with different clinical outcome of AF patients on anticoagulants. Further studies are needed in order assess whether PLT level should influence strategies of anticoagulation.

Klíčová slova:

Alcohol consumption – Atrial fibrillation – Death rates – Hypertension – Myocardial infarction – Platelets – Thrombocytopenia


Zdroje

1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Group ESCSD. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893–2962. doi: 10.1093/eurheartj/ehw210 27567408

2. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr., Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019.

3. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, Committee R-LS, Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139–1151. doi: 10.1056/NEJMoa0905561 19717844

4. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L, Committees A, Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981–992. doi: 10.1056/NEJMoa1107039 21870978

5. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM, Investigators RA. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883–891. doi: 10.1056/NEJMoa1009638 21830957

6. Ghoshal K, Bhattacharyya M. Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. ScientificWorldJournal 2014;2014:781857. doi: 10.1155/2014/781857 24729754

7. Koupenova M, Clancy L, Corkrey HA, Freedman JE. Circulating Platelets as Mediators of Immunity, Inflammation, and Thrombosis. Circ Res 2018;122:337–351. doi: 10.1161/CIRCRESAHA.117.310795 29348254

8. Park J, Cha MJ, Choi YJ, Lee E, Moon I, Kwak S, Kwon S, Yang S, Lee S, Choi EK, Oh S. Prognostic efficacy of platelet count in patients with nonvalvular atrial fibrillation. Heart Rhythm 2019;16:197–203. doi: 10.1016/j.hrthm.2018.08.023 30170225

9. Scharf RE. Do we need antiplatelet therapy in thrombocytosis? Contra. Proposal for an individualized risk-adapted treatment. Hamostaseologie 2016;36:241–260. doi: 10.5482/HAMO-16-06-0016 27414763

10. Koren-Michowitz M, Lavi N, Ellis MH, Vannucchi AM, Mesa R, Harrison CN. Management of extreme thrombocytosis in myeloproliferative neoplasms: an international physician survey. Ann Hematol 2017;96:87–92. doi: 10.1007/s00277-016-2826-4 27734130

11. Janion-Sadowska A, Papuga-Szela E, Lukaszuk R, Chrapek M, Undas A. Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Thrombocytopenia. J Cardiovasc Pharmacol 2018;72:153–160. doi: 10.1097/FJC.0000000000000607 29985282

12. Wang CL, Wu VC, Lee CH, Kuo CF, Chen YL, Chu PH, Chen SW, Wen MS, See LC, Chang SH. Effectiveness and safety of non-vitamin-K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients with thrombocytopenia. J Thromb Thrombolysis 2018.

13. Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008;111:4902–4907. doi: 10.1182/blood-2007-10-116327 18216292

14. Carrier M, Abou-Nassar K, Mallick R, Tagalakis V, Shivakumar S, Schattner A, Kuruvilla P, Hill D, Spadafora S, Marquis K, Trinkaus M, Tomiak A, Lee AYY, Gross PL, Lazo-Langner A, El-Maraghi R, Goss G, Le Gal G, Stewart D, Ramsay T, Rodger M, Witham D, Wells PS, Investigators A. Apixaban to Prevent Venous Thromboembolism in Patients with Cancer. N Engl J Med 2019;380:711–719. doi: 10.1056/NEJMoa1814468 30511879

15. Tefferi A, Barbui T. New and treatment-relevant risk stratification for thrombosis in essential thrombocythemia and polycythemia vera. Am J Hematol 2015;90:683–685. doi: 10.1002/ajh.24037 25872987

16. Hicks KA, Mahaffey KW, Mehran R, Nissen SE, Wiviott SD, Dunn B, Solomon SD, Marler JR, Teerlink JR, Farb A, Morrow DA, Targum SL, Sila CA, Thanh Hai MT, Jaff MR, Joffe HV, Cutlip DE, Desai AS, Lewis EF, Gibson CM, Landray MJ, Lincoff AM, White CJ, Brooks SS, Rosenfield K, Domanski MJ, Lansky AJ, McMurray JJV, Tcheng JE, Steinhubl SR, Burton P, Mauri L, O'Connor CM, Pfeffer MA, Hung HMJ, Stockbridge NL, Chaitman BR, Temple RJ; Standardized Data Collection for Cardiovascular Trials Initiative (SCTI). 2017 Cardiovascular and Stroke Endpoint Definitions for Clinical Trials. J Am Coll Cardiol. 2018;711021–1034.

17. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47. doi: 10.1161/CIRCULATIONAHA.110.009449 21670242


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Svět praktické medicíny 3/2024 (znalostní test z časopisu)
nový kurz

Kardiologické projevy hypereozinofilií
Autoři: prof. MUDr. Petr Němec, Ph.D.

Střevní příprava před kolonoskopií
Autoři: MUDr. Klára Kmochová, Ph.D.

Aktuální možnosti diagnostiky a léčby litiáz
Autoři: MUDr. Tomáš Ürge, PhD.

Závislosti moderní doby – digitální závislosti a hypnotika
Autoři: MUDr. Vladimír Kmoch

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#