A multicentric prospective study in usual care: D-dimer and cardiovascular events in patients with atrial fibrillation.

AIM: Atrial fibrillation (AF), the most frequent arrhythmia, is a major independent cardiovascular (CV) risk factor, especially in elderly patients. The interest of Ddimer (DD) measurement for predicting CV risk has been suggested in some subgroups of patients with AF but little is known about the negative prognostic value of DD measurement. The primary aim was to assess whether DD measurement and monitoring could predict the occurrence of subsequent CV events, defined as MI, stroke or transient ischemic attack and arterial embolic events.

METHODS AND RESULTS: It was a prospective observational study including patients with AF. Overall 425 patients (mean age 77years) were included and followed-up every 4months for a 16-months-mean duration. During this period, 26 patients experienced an endpoint of combined CV events. Patients with DD lower than 334ng/ml had a very low risk of suffering of CV events (1.7%). Patients who will suffer from a CV event had a higher DD value, just before the occurrence of the CV event, while patients without CV event kept stable levels.

CONCLUSION: We identified a DD threshold defining at any time patients at low risk of CV event. In addition, patients with higher DD levels are at higher risk of CV events, even if they are receiving oral anticoagulants. Otherwise, DD measurement is relevant in elderly patients. DD measurement and monitoring are useful to assess the risk of CV events in usual care. The implications of DD measurement on the choice and the intensity of the antithrombotic treatment remain to be determined.