Thrombocytopenia and Mortality Risk in Patients With Atrial Fibrillation: An Analysis From the START Registry. Issue 21 (5th November 2019)

• Record Type: Journal Article
• Authors: Pastori, Daniele; Antonucci, Emilia; Violi, Francesco; Palareti, Gualtiero; Pignatelli, Pasquale
• Other Names: Testa Sophie investigator.; Paoletti Oriana investigator.; Cosmi Benilde investigator.; Guazzaloca Giuliana investigator.; Migliaccio Ludovica investigator.; Poli Daniela investigator.; Marcucci Rossella investigator.; Maggini Niccolò investigator.; Pengo Vittorio investigator.; Falanga Anna investigator.; Lerede Teresa investigator.; Ruocco Lucia investigator.; Martini Giuliana investigator.; Pedrini Simona investigator.; Bertola Federica investigator.; Masciocco Lucilla investigator.; Saracino Pasquale investigator.; Benvenuto Angelo investigator.; Vasselli Claudio investigator.; Violi Francesco investigator.; Pignatelli Pasquale investigator.; Pastori Daniele investigator.; Grandone Elvira investigator.; Colaizzo Donatella investigator.; Marzolo Marco investigator.; Pinelli Mauro investigator.; Ageno Walter investigator.; Colombo Giovanna investigator.; Bucherini Eugenio investigator.; Serra Domizio investigator.; Toma Andrea investigator.; Barbera Pietro investigator.; Paparo Carmelo investigator.; Insana Antonio investigator.; Rupoli Serena investigator.; Malcangi Giuseppe investigator.; Zighetti Maddalena Loredana investigator.; Mangione Catello investigator.; Lione Domenico investigator.; Casasco Paola investigator.; Nante Giovanni investigator.; Tosetto Alberto investigator.; Oriana Vincenzo investigator.; Liberato Nicola Lucio investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 21(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-11-05
• Subjects: atrial fibrillation -- mortality -- thrombocytopenia; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.119.012596
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : 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 CHA2 DS2 VASc 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.