Abstract 9448: Soluble Fibrin Monomer-Fibrinogen Complex Levels during Oral Anticoagulant Therapy Does Not Predict Subsequent Thromboembolic Events in Patients with Atrial Fibrillation
Introduction: Atrial fibrillation (AF) is associated with hemostatic abnormality even during oral anticoagulant therapy. We previously reported that elevated D-dimer level predicted thromboembolic events in AF patients during oral anticoagulant therapy. Likewise, we assessed the hypothesis that soluble fibrin monomer-fibrinogen complex (SF) could be used for the prediction of thromboembolic events because it was considered to be a specific molecular marker for the detection of thrombin generation.
Subject and method: This study is a post hoc analysis of the previously reported cohort. Protocol 1 included 24 patients with permanent AF (77±10 y/o) in whom SF was measured before and after anticoagulant therapy with warfarin. Protocol 2 included 74 AF patients (75±10 y/o) undergoing treatments with warfarin. SF was measured during warfarin therapy and the patients were prospectively followed. The end point were thromboembolic events.
Results: Protocol1) Anticoagulation with warfarin significantly reduced SF levels (median, interquartile range) from 4.0 (0.0 - 8.8) to 0.0 (0.0 - 2.2) μ g/ml (left). However, SF levels were still elevated (≥3μ g/ml) in 3 (13%) patients. Protocol 2) INR levels at the time of enrollment were 2.0 ± 0.6. No relationship between SF levels and INR levels were observed (p=0.57). SF levels were ≥ 3 µg/ml in 13 (18%) patients. During an average follow-up time of 683±222 days, 8 (10.8%) thromboembolic events occurred. There were 7 thromboembolic events observed among patients with baseline SF levels < 3μ g/ml as compared with one event in those with baseline SF levels ≥3μ g/ml. Kaplan-Meier thromboembolic event free curve showed that elevated SF did not predictsubsequent thromboembolic events (right).
Conclusion: Warfarin significantly decreased SF levels; however, elevated level of SF during anticoagulant therapy failed to predict thromboembolic events in AF patients.
- © 2012 by American Heart Association, Inc.