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| [PMID]: | 28904234 |
| [Au] Autor: | Drabik L; Wolkow P; Undas A |
| [Ad] Endereço: | From the John Paul II Hospital, Krakow, Poland (L.D., A.U.), Centre for Medical Genomics-OMICRON (P.W.), Department of Pharmacology (L.D., P.W.) and Institute of Cardiology (A.U), Jagiellonian University Medical College, Krakow, Poland. |
| [Ti] Título: | Fibrin Clot Permeability as a Predictor of Stroke and Bleeding in Anticoagulated Patients With Atrial Fibrillation. |
| [So] Source: | Stroke;48(10):2716-2722, 2017 Oct. | | [Is] ISSN: | 1524-4628 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | BACKGROUND AND PURPOSE: Formation of denser fiber networks has been reported in atrial fibrillation and ischemic stroke. In this longitudinal cohort study, we evaluated whether fibrin clot density may predict thromboembolic and bleeding risk in patients with atrial fibrillation on vitamin K antagonists. METHODS: In 236 patients with atrial fibrillation receiving vitamin K antagonists treatment, we measured ex vivo plasma clot permeability (K ), a measure of the pore size in fibrin networks. RESULTS: During a median follow-up of 4.3 (interquartile range, 3.7-4.8) years, annual rates of ischemic stroke or transient ischemic attack and major bleeds were 2.96% and 3.45%, respectively. In multivariate Cox regression analysis, patients with lower K (<6.8 cm ×10 , median) had increased risk of ischemic stroke or transient ischemic attack (hazard ratio [HR], 6.55; 95% confidence interval [CI], 2.17-19.82) and major bleeds (HR, 10.65; 95% CI, 3.52-32.22). Patients with elevated K (≥6.8 cm ×10 ) had an increased rate of minor bleeding compared with the remainder (11.63% per year versus 3.55% per year; <0.0001). The independent predictors of stroke or transient ischemic attack were low K (<6.8 cm ×10 ; HR, 7.24; 95% CI, 2.53-20.76), age (HR, 1.05; 95% CI, 1.01-1.10), and treatment with angiotensin-converting enzyme inhibitors (HR, 2.27; 95% CI, 1.08-4.77). Major bleeds were predicted by low K (<6.8 cm ×10 ; HR, 8.48; 95% CI, 2.99-24.1) and HAS-BLED score ≥3 (HR, 2.22; 95% CI, 1.12-4.38). CONCLUSIONS: This study is the first to show that unfavorable fibrin properties reflected by formation of denser fibrin networks determine, in part, the efficacy and safety of anticoagulation with vitamin K antagonists in patients with atrial fibrillation. |
| [Mh] Termos MeSH primário: |
Anticoagulantes/uso terapêutico
Fibrilação Atrial/sangue
Fibrina/metabolismo
Hemorragia/sangue
Acidente Vascular Cerebral/sangue
Trombose/sangue
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| [Mh] Termos MeSH secundário: |
Idoso
Anticoagulantes/efeitos adversos
Anticoagulantes/farmacologia
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/tratamento farmacológico
Coagulação Sanguínea/efeitos dos fármacos
Coagulação Sanguínea/fisiologia
Permeabilidade Capilar/efeitos dos fármacos
Permeabilidade Capilar/fisiologia
Estudos de Coortes
Feminino
Seguimentos
Hemorragia/induzido quimicamente
Hemorragia/diagnóstico
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Valor Preditivo dos Testes
Acidente Vascular Cerebral/diagnóstico
Acidente Vascular Cerebral/tratamento farmacológico
Trombose/diagnóstico
Trombose/tratamento farmacológico
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE |
[Nm] Nome de substância:
| 0 (Anticoagulants); 9001-31-4 (Fibrin) |
| [Em] Mês de entrada: | 1710 |
| [Cu] Atualização por classe: | 171009 |
[Lr] Data última revisão:
| 171009 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 170915 |
| [St] Status: | MEDLINE |
| [do] DOI: | 10.1161/STROKEAHA.117.018143 |
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