Erythrocyte and platelet indices in evaluating the safety of antithrombotic therapy in patients diagnosed with atrial fibrillation

Introduction: Atrial fibrillation is one of the most frequent arrythmias in cardiovascular patients, with disabling, potentially lethal thromboembolic complica-tions. Taking into consideration additional, age-related comorbidities, prevention of these complications by anticoagulation is one of the main attitudes in AF ma-nagement, along with monitoring the risk of bleeding. Objective: To evaluate the safety of anticoagulant and platelet antiaggregant therapy, in patients diagno-sed with AF, through a simple complete blood count (CBC), inferring subclinical hemorrhage from stan-dard parameter deviations.
Methods: T his observational and retrospective study was conducted on 300 patients hospitalized in Colțea Clinical Hospital, between January 1 and December 31, 2017 (mean patient age 74.77±9.01 years old, 59% women, 41% men). Patients who had been diagnosed with AF and had been treated with either anticoagulant or antiaggregant prior to admission were included in the study. Statistical analysis was performed with IBM SPSS Statistics 23.0 software. Patients were divided into three groups, according to the type of medication (an-tiaggregant or type of anticoagulants). The appropriate parametric or non-parametric mean comparison tests, as well as tests of non-parametric correlation, were em-ployed.
Results: Out of 300 selected patients, 10.7% (n=32) had been treated with antiaggregants (AA), 58.3% (n=175) with vitamin K antagonists (VKA) and 31% (n=93) with non-vitamin K antagonist oral anticoagulants (NOAC). The age distribution across the three groups differed significantly (79.94±1.50 years old, 95% CI, 76.86-83.01 for AA; 73.03±0.67 years old, 95% CI, 71.70-74.37 for VKA; 79.94±1.5 years old, 95% CI, 76.86-83.01 for NOAC). A negative correlation between age and hemoglobin value was observed (Spearman ρ=- 0.241, p<0.001). With one sole exception, the distribution of other CBC parameters like hemoglobin, mean erythrocyte volume, red cell distribution width, mean platelet volume, platelet distribution width, were similar between groups. Furthermore, no difference was detected in terms of renal function, as reflected by the serum creatinine levels and estimated glomerular filtration rate. The only CBC variable displaying significant difference across groups was platelet count, with mean values of 270.67±8.87×10^5/μL for NOAC (95% CI, 253.05-288.29×10^5/μL), 255.12±6.27×10^5/μL for VKA (95% CI, 242.74-267.5×10^5/μL), and 227.75±12.96×10^5/μL for   AA   (95%  CI,    201.3-254.19×10^5/μL).
Conclusions: As far as indexes regarding erythrocytes and thrombocytes are concerned, there are no diffe-rences between the three analyzed groups of patients except number of platelets. Bearing in mind that these markers dynamically modify when a visible or subcli-nical hemorrhage occurs, we can consider that antia-ggregants, NOAC and anti-vitamin K drugs are equally safe in AF patients as far as hemorrhage risk is concer-ned.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)