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Subtle renal dysfunction and bleeding risk in atrial fibrillation : Symmetric dimethylarginine predicts HAS-BLED score
Procter, Nathan Ball, Jocasta Heresztyn, Tamila Nooney, Vivek Liu, Saifei Chong, Cher-Rin Ngo, Doan Isenberg, Jeffrey Chirkov, Yuliy Stewart, Simon
Procter, Nathan
Ball, Jocasta
Heresztyn, Tamila
Nooney, Vivek
Liu, Saifei
Chong, Cher-Rin
Ngo, Doan
Isenberg, Jeffrey
Chirkov, Yuliy
Stewart, Simon
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Abstract
Background: Risk of substantial haemorrhage represents a critically important limitation to effective anti-thrombotic treatment in patients with atrial fibrillation (AF). While it is known that this risk is increased in anticoagulated patients either in the presence of anti-aggregatory drugs or concomitant renal insufficiency, there are currently few data on the potential interactions between endogenous platelet aggregability and bleeding risk. Objective: We therefore evaluated in a cohort of AF patients: (1), the putative relationship between platelet aggregability and HAS-BLED score; (2), the potential biochemical bases for such a relationship. Methods: Patients were included as part of SAFETY, a randomised controlled trial evaluating outpatient management of AF patients. Platelet response to ADP was evaluated via whole blood impedance aggregometry; clinical and biochemical correlates of platelet aggregation were sought via univariate and multivariate analysis. Results: Platelet aggregation correlated inversely (r=-0.220, p < 0.05) with HAS-BLED score. Univariate biochemical correlates of decreased platelet aggregation were plasma concentrations of symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). On multivariate analyses, plasma SDMA concentration (β=-0.318, p < 0.01), platelet content of thioredoxin-interacting protein (Txnip, β=0.261, p < 0.05) and plasma thrombospondin-1 (TSP-1, β=0.249, p < 0.05) concentration were predictive of platelet ADP response. Consistent with previous reports, plasma SDMA concentrations were strongly and inversely correlated with estimated glomerular filtration rate (eGFR, r=-0.780, p < 0.001). Conclusions: These data therefore suggest that (1), physiologically impaired, like pharmacologically impaired, platelet aggregability may increase bleeding risk in anticoagulated AF patients; (2), the biochemical basis for this may include impaired effects of nitric oxide (via Txnip, TSP-1) but also concomitant renal dysfunction.
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Date
2015
Type
Journal article
Journal
American Journal of Cardiovascular Disease
Book
Volume
5
Issue
2
Page Range
101-109
Article Number
ACU Department
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