Key result
Ineffective warfarin treatment (INR <2.0) in non-valvular atrial fibrillation is associated with significantly higher mean platelet volume, platelet distribution width, and plateletcrit.
Why the study?
Do platelet indices differ between patients with non-valvular atrial fibrillation on effective versus ineffective warfarin therapy?
Observational (n=373)
Do platelet indices differ between patients with non-valvular atrial fibrillation on effective versus ineffective warfarin therapy?
Platelet indices such as MPV, PDW, and PCT are elevated in non-valvular AF patients with subtherapeutic INR and may serve as useful parameters for monitoring warfarin effectiveness.
Subtherapeutic INR links to higher platelet indices in non-valvular AF; hypothesis-generating and should not yet change practice.
Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with adverse outcomes and increased risk for thromboembolic events. Warfarin is still the most extensively prescribed oral anticoagulant in AF to prevent ischemic complications. We aimed to determine the differences at platelet indices with warfarin usage layered by International Normalized Ratio (INR). A total of 250 patients with permanent non-valvular AF (mean age 70.2 ± 9.1; 153 female) were divided into two groups. Group 1 included 125 patients whose INR is between 2.0 and 3.0 (called as "effective") and Group 2 included 125 patients whose INR is <2.0 (called as "ineffective"). Also 123 age- and sex-matched individuals in sinus rhythm enrolled as control group (Group 3). After physical and echocardiographic examination, complete blood counts and INR were studied. There was no statistically significant difference in age, sex, co-morbidities and medications, also hemoglobin, white blood cell and platelet counts among the groups. The CHA2DS2-VASc scores were similar between Groups 1 and 2. The mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) were significantly higher in Group 2 than Groups 1 and 3 and similar between Groups 1 and 3. MPV was positively correlated with PDW and PCT and also inversely correlated with INR value and platelet count. On multivariate logistic regression analysis, MPV, PDW and PCT were independent predictors of ineffectiveness of INR. The results of this study showed that MPV, PDW and PCT are increased in patients with non-valvular AF without effective warfarin treatment. Warfarin usage adjusted by INR is associated with lower values of these platelet indices, even lower as the values of subjects in sinus rhythm. MPV, PDW and PCT are independent predictors of INR ineffectiveness and seem to be useful parameters for monitoring the effectiveness of warfarin treatment.
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Arık et al. (2013) conducted an observational in non-valvular atrial fibrillation (n=373). Ineffective warfarin treatment (INR <2.0) vs. Effective warfarin treatment (INR 2.0-3.0) and sinus rhythm controls was evaluated on Platelet indices (MPV, PDW, and PCT). Ineffective warfarin treatment (INR <2.0) in non-valvular atrial fibrillation is associated with significantly higher mean platelet volume, platelet distribution width, and plateletcrit.
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