Are elevated factor VIIa-antithrombin complexes associated with an increased risk of ischemic stroke, systemic thromboembolism, or cardiovascular death in patients with atrial fibrillation?
High plasma FVIIa-AT complexes are strongly and independently associated with thromboembolic events or cardiovascular death in patients with atrial fibrillation.
BACKGROUND: Atrial fibrillation (AF) is associated with a prothrombotic state. We investigated whether factor VIIa-antithrombin (FVIIa-AT) complexes, a marker of tissue factor (TF) exposure, are associated with thromboembolic events in AF. METHODS: VASc score 4), 71% on direct oral anticoagulants, we measured FVIIa-AT complexes, along with endogenous thrombin potential (ETP), von Willebrand factor (VWF) and 8-isoprostane, reflecting oxidative stress. During a median follow-up of 53 interquartile range, IQR 47-57 months, we recorded a composite endpoint: ischemic stroke, systemic thromboembolism or cardiovascular (CV) death. RESULTS: FVIIa-AT complexes (median 145 IQR 125-170 pM) were higher in patients with permanent AF (p 170 pM) had an increased risk of the composite endpoint (HR 12.0, 95% CI 5.2-28.0, p < .0001). FVIIa-AT complexes, along with VWF, remained independently associated with the composite endpoint. CONCLUSIONS: This study is the first to show that high plasma FVIIa-AT complexes are independently associated with thromboembolic events or CV death in AF, suggesting the need for more potent anticoagulation to suppress the residual TF-mediated coagulation.
Szczygieł‐Pilut et al. (Thu,) studied this question.
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