Key result
Moderate-severe thrombocytopenia shows no independent link to higher mortality versus normal platelet counts.
Why the study?
Thrombocytopenia increases mortality in the general population, but few data exist on its determinants and association with total mortality in patients with AF taking oral anticoagulants.
Is thrombocytopenia associated with increased all-cause mortality in patients with atrial fibrillation taking oral anticoagulants?
Cohort (n=5,215)
Yes
Is thrombocytopenia associated with increased all-cause mortality in patients with atrial fibrillation taking oral anticoagulants?
Hazard Ratio: 2.431 (95% CI 1.254–4.713)
Absolute Event Rate: 9.9% vs 3.8%
p-value: p=0.009
Thrombocytopenia is common in AF patients on oral anticoagulants and is associated with higher crude mortality, but this risk is likely driven by underlying comorbidities rather than thrombocytopenia itself.
Unadjusted mortality link with thrombocytopenia may reflect confounding; leaves open its independent prognostic value.
Background Thrombocytopenia is associated with increased mortality in the general population, but few data exist in patients with atrial fibrillation ( AF ) taking oral anticoagulants. We investigated factor determinants of thrombocytopenia in a large cohort of patients affected by AF and its association with total mortality. Methods and Results Multicenter prospective cohort study, including 5215 patients with AF from the START (Survey on Anticoagulated Patients Register) registry, 3877 (74.3%) and 1338 (25.7%) on vitamin K or non–vitamin K antagonist oral anticoagulants, respectively. Thrombocytopenia was defined by a platelet count <150×10 9 /L. Determinants of thrombocytopenia were investigated, and all‐cause mortality was the primary survival end point of the study. Thrombocytopenia was present in 592 patients (11.4%). At multivariable logistic regression analysis, chronic kidney disease (odds ratio [ OR], 1.257; P =0.030), active cancer ( OR, 2.065; P =0.001), liver cirrhosis ( OR, 7.635; P <0.001), and the use of diuretics ( OR, 1.234; P =0.046) were positively associated with thrombocytopenia, whereas female sex ( OR, 0.387; P <0.001) and the use of calcium channel blockers ( OR, 0.787; P =0.032) were negatively associated. During a median follow‐up of 19.2 months (9942 patient‐years), 391 deaths occurred (rate, 3.93%/year). Mortality rate increased from 3.8%/year to 9.9%/year in patients with normal platelet count and in those with moderate‐severe thrombocytopenia, respectively (log‐rank test, P =0.009). The association between moderate‐severe thrombocytopenia and mortality persisted after adjustment for CHA 2 DS 2 VAS c score (hazard ratio, 2.431; 95% CI, 1.254–4.713; P =0.009), but not in the fully adjusted multivariable Cox regression analysis model. Conclusions Thrombocytopenia is common in patients with AF . Despite an increased incidence of mortality, thrombocytopenia was not associated with mortality at multivariable analysis. Thrombocytopenia may reflect the presence of comorbidities associated with poor survival in AF .
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Pastori et al. (2019) conducted a cohort in Atrial Fibrillation (n=5,215). Moderate-severe thrombocytopenia vs. Normal platelet count was evaluated on All-cause mortality (HR 2.431, 95% CI 1.254-4.713, p=0.009). Moderate-severe thrombocytopenia was associated with a higher mortality rate than normal platelet counts (9.9% vs 3.8%/year), but this association did not persist in fully adjusted analysis.
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