D‐dimer and risk of thromboembolic and bleeding events in patients with atrial fibrillation – observations from the ARISTOTLE trial

Background D‐dimer is related to adverse outcomes in arterial and venous thromboembolic diseases. Objectives To evaluate the predictive value of D‐dimer level for stroke, other cardiovascular events, and bleeds, in patients with atrial fibrillation (AF) treated with oral anticoagulation with apixaba...

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Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2014-09, Vol.12 (9), p.1401-1412
Main Authors: Christersson, C., Wallentin, L., Andersson, U., Alexander, J. H., Ansell, J., De Caterina, R., Gersh, B. J., Granger, C. B., Hanna, M., Horowitz, J. D., Huber, K., Husted, S., Hylek, E. M., Lopes, R. D., Siegbahn, A.
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Anticoagulants - therapeutic use
apixaban
atrial fibrillation
Atrial Fibrillation - blood
Atrial Fibrillation - complications
Cohort Studies
D-dimer
Embolism - blood
Female
Fibrin Fibrinogen Degradation Products - metabolism
Fibrinolytic Agents - chemistry
Hemorrhage
Humans
Incidence
Male
Middle Aged
Predictive Value of Tests
Pyrazoles - administration & dosage
Pyridones - administration & dosage
Risk Assessment
Risk Factors
Stroke - blood
Thromboembolism - blood
Treatment Outcome
Vitamin K - antagonists & inhibitors
warfarin
Warfarin - administration & dosage
Warfarin - therapeutic use
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Summary:Background D‐dimer is related to adverse outcomes in arterial and venous thromboembolic diseases. Objectives To evaluate the predictive value of D‐dimer level for stroke, other cardiovascular events, and bleeds, in patients with atrial fibrillation (AF) treated with oral anticoagulation with apixaban or warfarin; and to evaluate the relationship between the D‐dimer levels at baseline and the treatment effect of apixaban vs. warfarin. Methods In the ARISTOTLE trial, 18 201 patients with AF were randomized to apixaban or warfarin. D‐dimer was analyzed in 14 878 patients at randomization. The cohort was separated into two groups; not receiving vitamin K antagonist (VKA) treatment and receiving VKA treatment at randomization. Results Higher D‐dimer levels were associated with increased frequencies of stroke or systemic embolism (hazard ratio [HR] [Q4 vs. Q1] 1.72, 95% confidence interval [CI] 1.14–2.59, P = 0.003), death (HR [Q4 vs. Q1] 4.04, 95% CI 3.06–5.33) and major bleeding (HR [Q4 vs. Q1] 2.47, 95% CI 1.77–3.45, P 
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.12638