Thrombocytopenia and thrombocytosis are associated with different outcome in atrial fibrillation patients on anticoagulant therapy

English version

Autoři: Yoav Michowitz ^aff001; Robert Klempfner ^aff002; Nir Shlomo ^aff002; Ilan Goldenberg ^aff004; Maya Koren-Michowitz ^aff002
Působiště autorů: Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel ^aff001; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel ^aff002; Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel ^aff003; Clinical Cardiovascular Research Center, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States of America ^aff004; Department of Hematology, Shamir Medical Center (Asaf Harofeh), Zerifin, Israel ^aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224709

Souhrn

Background

Information regarding the significance of platelet (PLT) count on outcome of atrial fibrillation (AF) patients who are treated with anticoagulants is limited.

Methods

We conducted a monocentric observational retrospective cohort study of AF patients treated with either warfarin (n = 6287) or non-vitamin K antagonist oral anticoagulants (NOACs) (n = 5240). Patient were divided into 3 subgroups; low, normal and high PLT for counts < 150 K/ μl, 150–450 K/ μl and > 450 K/ μl, respectively. A multivariate Cox-regression was used to evaluate the association between PLT subgroups and clinical outcomes.

Results

During follow-up [median = 40.6 months (IQR 17.6–60)], mortality (HR 1.36, 95 CI 1.1–1.74, p = 0.01) and rate of myocardial infarction (MI) (HR 2.4, 95 CI 1.28–4.57, p = 0.007) were higher in patients with high compared to normal PLT. Transient ischemic attack or cerebrovascular accident (TIA/CVA) rate was lower in patients with low compared to normal PLT (HR 0.69, 95 CI 0.51–0.93, p = 0.02). A comparison between NOACs and warfarin demonstrated a significantly better clinical outcome for patients on NOACs in both the low (lower mortality rates) and normal PLT subgroup (lower mortality, TIA/CVA and systemic emboli rates). For patients on NOACs, low and high compared to normal PLT were associated with a higher combined outcome (HR 1.12, 95 CI 1–1.38, p = 0.047), and a higher systemic emboli rate (HR 7.07, 95 CI 1.66–30.25, p = 0.008), respectively.

Conclusions

Abnormal PLT count is associated with different clinical outcome of AF patients on anticoagulants. Further studies are needed in order assess whether PLT level should influence strategies of anticoagulation.

Klíčová slova:

Death rates – Alcohol consumption – Hypertension – Myocardial infarction – Atrial fibrillation – Platelets – Thrombocytopenia

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