D-dimer level influences thromboembolic events in patients with atrial fibrillation

Int J Cardiol. 2006 Apr 28;109(1):59-65. doi: 10.1016/j.ijcard.2005.05.049. Epub 2005 Jul 1.


Background: Elevated coagulative molecular markers could reflect the prothrombotic state in the cardiovascular system of patients with non-valvular atrial fibrillation (NVAF). A prospective, cooperative study was conducted to determine whether levels of coagulative markers alone or in combination with clinical risk factors could predict subsequent thromboembolic events in patients with NVAF.

Methods: Coagulative markers of prothrombin fragment 1+2, D-dimer, platelet factor 4, and beta-thromboglobulin were determined at the enrollment in the prospective study.

Results: Of 509 patients with NVAF (mean age, 66.6 +/- 10.3 years), 263 patients were treated with warfarin (mean international normalized ratio, 1.86), and 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significantly better in patients with D-dimer level < 150 ng/ml than in those with D-dimer level>or==150 ng/ml. Other coagulative markers, however, did not predict thromboembolic events. Age (>or==75 years), cardiomyopathies, and prior stroke or transient ischemic attack were independent, clinical risk factors for thromboembolism. Thromboembolic risk in patients without the clinical risk factors was quite low (0.7%/year) when D-dimer was < 150 ng/ml, but not low (3.8%/year) when D-dimer was >or==150 ng/ml. It was >5%/year in patients with the risk factors regardless of D-dimer levels. This was also true when analyses were confined to patients treated with warfarin.

Conclusions: D-dimer level in combination with clinical risk factors could effectively predict subsequent thromboembolic events in patients with NVAF even when treated with warfarin.

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / blood*
  • Atrial Fibrillation / complications*
  • Biomarkers / blood
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Peptide Fragments / blood
  • Platelet Factor 4 / analysis
  • Predictive Value of Tests
  • Prospective Studies
  • Prothrombin
  • Stroke / etiology
  • Stroke / prevention & control
  • Thromboembolism / blood
  • Thromboembolism / etiology*
  • Thromboembolism / prevention & control
  • Warfarin / therapeutic use
  • beta-Thromboglobulin / analysis


  • Anticoagulants
  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Peptide Fragments
  • beta-Thromboglobulin
  • fibrin fragment D
  • prothrombin fragment 1.2
  • Platelet Factor 4
  • Warfarin
  • Prothrombin