Prediction of unstable anticoagulation with acenocoumarol versus warfarin in atrial fibrillation

Background: The SAMe-TT2R2 (sex female, age, medical history, treatment, tobacco use, race) score was developed in patients with atrial fibrillation (AF) on warfarin. The present study aimed to 1) compare the anticoagulation quality and management of AF patients treated with warfarin with those on acenocoumarol and 2) optimize the SAMe-TT2R2 score to detect AF patients at high risk of unstable anticoagulation with acenocoumarol and warfarin. Methods: In a single-center retrospective study, 320 patients with AF, including 15 (5%) after valve replacement, aged 40–82 (median 70) years, including 203 (63%) receiving acenocoumarol and 117 (37%) treated with warfarin, were studied. The SAMe-TT2R2 score was modified based on the candidate factors retrieved from univariate regression and assessed using the receiver operating curves (ROC). Results: A median SAMe-TT2R2 score was 2 (1–3). Proportions of patients with ≥ 2 points and 0–1 points in the SAMe-TT2R2 score who had the time in therapeutic range (TTR) ≤ 70% were similar (61 [67%] vs. 63 [56%], p = 0.11). A modified score, involving medical history (myocardial infarction [MI] and chronic obstructive pulmonary disease [COPD], 1 point), statin treatment (1 point) and tobacco use (2 points) had a higher area under the curve (AUC) in patients on acenocoumarol compared to SAMe- TT2R2 (0.66; 95% confidence interval 0.58–0.73 vs. 0.56; 0.48–0.64, p = 0.042); ≥ 1 point indicated TTR > 70% with a sensitivity and specificity of 61% and 63%, respectively. Conclusions: The SAMe-TT2R2 score is less effective in predicting unstable anticoagulation with acenocoumarol versus warfarin. Adding statin use and highlighting COPD and previous MI increases a predictive value of this score for acenocoumarol.

Psoriasis is an independent predictor of increased risk of allergic reaction during percutaneous coronary interventions. Big data analysis from the Polish National PCI Registry (ORPKI)

Background: The presence of psoriasis is currently considered by the European Society of Cardiology cardiovascular prevention guidelines of 2016 as one possible cardiovascular risk factor. Patients with psoriasis and concomitant coronary artery disease treated by means of percutaneous coronary interven­tion (PCI) are a fairly large subgroup of patients that have been usually omitted in mainstream research. The aim herein, was to identify the incidence of psoriasis, baseline characteristics and periprocedural outcome with a special focus on procedural complications in patients undergoing percutaneous coronary procedures. Methods: All consecutive patients who had either coronary angiography or coronary angiography with immediate PCI in Poland in 2014 and 2015 were included. Patients were assigned to two groups based on previous diagnosis: with psoriasis and without psoriasis. Clinical outcome was defined as any periprocedural death. Results: There were 405,078 patients included in this analysis. Psoriasis (moderate or severe) was di­agnosed in 1507 (0.4%) of them. Psoriasis was an independent predictor of allergic reaction occurrence (odds ratio [OR] 6.02; 95% confidence interval [CI] 1.44–25.22; p = 0.014). After propensity score adjustment, psoriasis remained a significant predictor of allergic reaction (OR 5, 95% CI 1.2–20.7; p = 0.0245). There were no differences in rates of periprocedural deaths in patients with or without psoriasis (death: 0.95% vs. 0.62%, p > 0.05). Conclusions: Severe or moderate psoriasis is an independent risk factor for the occurrence of allergic reaction during percutaneous coronary procedures. There were no differences in periprocedural mortal­ity and complications in patients with versus those without psoriasis

Activated factor IX, factor XI and tissue factor identify patients with permanent atrial fibrillation treated with warfarin who are at risk of ischemic stroke

Introduction: Previously, we have demonstrated that significant proportions of patients with various cardiovascular diseases have active tissue factor and active factor XIa in their plasma. In the current study, we evaluated active tissue factor and active factors (F)XI and FIX in plasma from patients with atrial fibrillation. Material and methods: In 110 consecutive patients with permanent atrial fibrillation receiving warfarin, we determined active tissue factor, together with plasma FIXa and FXIa, using clotting assays by measuring the response to inhibitory monoclonal antibodies. Results: Sixteen (14.5%) patients had detectable active tissue factor and active FXIa, including 11 subjects with both factors, while FIXa was observed in 28 (25.7%) patients. The three positive groups did not differ from the patients without these factors with regard to demographic and clinical characteristics. Von Willebrand factor was higher in the active tissue factor-positive group (p < 0.0001) and FXIa-positive group (p = 0.0037). Individuals positive for active tissue factor and FXIa had higher plasma interleukin-6 levels (p = 0.0014 and 0.0322, respectively). The presence of active tissue factor, FXIa and FIXa in anticoagulated patients with permanent atrial fibrillation correlated with elevated von Willebrand factor and interleukin-6. During a 3-year follow-up, ischemic stroke (n = 12, 10.9%) occurred more commonly among atrial fibrillation patients who had circulating TF (p = 0.002) or FXIa (p = 0.013). Conclusions: These data suggest that circulating active coagulation factors, in particular TF and FXIa, can be detected despite oral anticoagulation in a significant proportion of patients with atrial fibrillation, and could represent novel markers of persistent prothrombotic alterations predisposing to ischemic stroke