Abstract 18321: D-dimer is Prognostic for Stroke, Major Bleeding and Death During Anticoagulation of Atrial Fibrillation - a RELY Substudy
Background: The D-dimer level during anticoagulation treatment of atrial fibrillation (AF) is related to the risk of thromboembolic events. The prognostic value of D-dimer in addition to CHADS2 risk factors was investigated in AF patients treated with warfarin or Dabigatran
Methods: In the RELY study 18113 patients with AF and at least one risk factor for thromboembolism, average age of 71 years, were randomized to dabigatran or warfarin and followed for 2.0 years median treatment duration. We analyzed plasma concentrations of D-dimer (Asserachrome, Stago, France) at randomization in 6170 patients and evaluated its association to CV events.
Results: Increasing baseline concentrations of D-dimer (quartile groups) were significantly associated with the risk of stroke, cardiovascular (CV) death and major bleeding after multivariable adjustment for CHADS2 risk factors and study drug. Separate analyses of patients receiving anticoagulants (n=4205) and those not receiving anticoagulants (n=1965) at the time of blood sampling yielded similar results, and interaction tests for pre-study anticoagulation and for study drug assignment were non-significant.
*effect of the D-dimer quartile groups, Cox proportional hazards model
Conclusion: The concentration of D-dimer at start of treatment with warfarin or dabigatran is strongly related to the risk of stroke, death and bleeding independently of CHADS2 risk factors and baseline anticoagulant treatment. Measurement of D-dimer might therefore be useful to optimize patient selection and the intensity of anticoagulant treatment in atrial fibrillation.
- © 2010 by American Heart Association, Inc.