Impact of decreased renal function on coagulation and fibrinolysis in patients with non-valvular atrial fibrillation.
BACKGROUND
The prothrombotic state in non-valvular atrial fibrillation (NVAF) increases the risk of thromboembolic events. It is also well known that a prothrombotic state exists in renal failure. Hemostatic disorders play a role in thromboembolic mortality in both NVAF and renal failure. However, little is known about the influence of renal function on hemostasis in patients with NVAF.


RESULTS
A total of 190 consecutive outpatients with NVAF who were not receiving anticoagulant therapy were enrolled in the present study. Patients were stratified in groups based on estimated glomerular filtration rate (eGFR). Plasma concentrations of thrombin-antithrombin complex (TAT) and D-dimer were measured and the influence of renal function on coagulation and fibrinolysis was assessed. A relatively weak and inverse relationship of eGFR to TAT and D-dimer was observed (r=0.28, P=0.0001; r=0.30, P<0.0001). Both mean TAT and D-dimer concentrations in groups gradually and significantly increased as eGFR decreased (P<0.0001). On multivariate regression analysis, decreased eGFR concentration was a significant predictor for elevation of TAT (P<0.05) and D-dimer (P<0.01) in patients with NVAF.


CONCLUSIONS
The enhanced coagulation activation appeared to be related to a reduction in residual renal function in patients with NVAF. This suggests that decreased renal function might be a candidate predictor of thromboembolic events in patients with NVAF.
The Second Department of Cardiology, National Hospital Organization Kagoshima Medical Center, Japan. tanakahi@kagomc2.hosp.go.jp
Hideki
H
Tanaka
Masahiro
M
Sonoda
Katsuro
K
Kashima
Yasuhiro
Y
Tanaka
Kazuhiko
K
Nakamura
Norihito
N
Nuruki
Hirohito
H
Tsubouchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D010447:Peptide Hydrolases