Key result
Elevated Von Willebrand factor linked to increased thromboembolism and mortality risk in NVAF.
Why the study?
Von Willebrand factor elevation correlates with left atrial blood stasis in nonvalvular atrial fibrillation, but the long-term impact of elevated VWF in these patients is not well established.
Do baseline levels of VWF and ADAMTS13 predict thromboembolism, bleeding, and mortality in patients with nonvalvular atrial fibrillation?
Cohort (n=414)
Do baseline levels of VWF and ADAMTS13 predict thromboembolism, bleeding, and mortality in patients with nonvalvular atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Elevated Von Willebrand factor is an independent predictor of all-cause mortality and a composite of thromboembolism and mortality in patients with nonvalvular atrial fibrillation, potentially aiding in risk stratification beyond CHA2DS2-VASc.
BackgroundVon Willebrand factor (VWF) elevation correlates with the left atrial blood stasis in nonvalvular atrial fibrillation (NVAF). However, the long-term impact of elevated VWF in patients with NVAF is not well established.MethodsTo assess the impact of VWF and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13) in conjunction with echocardiographic measures of left atrium blood stasis on clinical outcomes, 414 NVAF prospectively recruited (October 4, 2007, to April 27, 2009) patients were followed for 3 years. VWF antigen, VWF activity, ADAMTS13 activity, and echocardiographic findings were assessed at baseline. Thromboembolism (TE) (stroke/transient ischemic attack (TIA)), myocardial infarction, or TE of other locations), major bleeding, clinically relevant nonmajor bleeding, and all-cause mortality were assessed by clinical follow-up, questionnaire, or telephone communication.ResultsAmong 374 patients (mean age, 63.4 ± 12.7 years; 25% females) who had complete follow-up data, there were 33 TE in 32 patients (8.6%), 18 deaths (5.1%), and 33 bleeding events (21 major bleeding and 12 clinically relevant nonmajor bleeding) in 25 patients (6.7%). VWF antigen was predictive of TE in the univariate examination (hazard ratio [HR]: 1.007, 95% confidence interval [CI]: 1.002, 1.013, P = 0.011) but not in multivariate analysis. VWF was an independent predictor of all-cause mortality (HR: 1.011, 95% CI: 1.003, 1.020, P = 0.011) and a composite of TE and all-cause mortality (HR: 1.006, 95% CI: 1.001, 1.012, P = 0.039) in multivariate analysis. ADAMTS13 was not predictive of clinical outcomes in multivariate analysis.ConclusionsAmong patients with NVAF, VWF is an independent predictor of poor outcomes including death and a composite of death and TE. As such, VWF measure may help identify high-risk patients and provide further stratification beyond CHA2DS2-VASc assessment.
No takes yet. Share an insight, caveat, or question.
Wysokiński et al. (2020) conducted a cohort in Nonvalvular Atrial Fibrillation (n=414). Von Willebrand factor (VWF) and ADAMTS13 assessment was evaluated on Composite of thromboembolism and all-cause mortality (HR 1.006, 95% CI 1.001-1.012, p=0.039). Elevated Von Willebrand factor was an independent predictor of a composite of thromboembolism and all-cause mortality (HR 1.006; 95% CI 1.001-1.012; P=0.039) in patients with nonvalvular atrial fibrillation.
Synapse has enriched 10 related papers. Consider them for comparative context: