Prognostic implication of monocytes in atrial fibrillation: The West Birmingham Atrial Fibrillation Project.

BACKGROUND AND OBJECTIVES: High monocyte counts are related to adverse outcomes in cardiovascular disease. Their role in prognostication in patients with atrial fibrillation (AF) is unknown. We investigated whether monocyte counts are useful as a marker of prognosis in patients with AF. METHODS: Monocyte counts were obtained from blood samples in 881 AF patients. Study outcomes were (i) all-cause death; (ii) major adverse cardiovascular events; (iii) stroke, TIA or other systemic embolism (SSE); and (iv) major bleeding. RESULTS: Median follow up was 7.2 years; 44% of patients died, 48% developed MACE; 9% had SSE and 5% had major bleeding. On Cox regression, after adjustment for CHA2DS2-VASc score, the highest quartile of monocyte counts (i.e., ≥580 µL vs. other quartiles) was associated with increased risk of death (hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.31-2.05, p<0.001) and MACE (HR 1.58, 95% CI 1.28-1.96, p<0.001). Persistent monocyte levels ≥580 per µL during follow up were associated with further increase in risk of death (HR 1.52, 95% CI 1.10-2.11, p = 0.01) and MACE (HR 1.54, 95% CI 1.13-2.09, p = 0.006). Persistent monocyte levels ≥580 per µL during were associated with a significant increase in major bleeding events (HR 2.77, 95% CI 1.36-5.67, p = 0.005, after adjustment for HAS-BLED score). CONCLUSION: High monocyte counts independently predict the occurrence of MACE, major bleeding and mortality, but not SSE. Understanding the pathophysiological mechanisms involved would help understand the relationships between monocytes, and adverse thrombotic and bleeding outcomes in AF patients.

Monitoring the Effects and Antidotes of the Non-vitamin K Oral Anticoagulants.

In the last decade, we have witnessed the emergence of the oral non-vitamin K oral anticoagulants (NOACs), which have numerous advantages compared with the vitamin K antagonists, particularly their lack of need for monitoring; as a result their use is increasing. Nonetheless, the NOACs face two major challenges: the need for reliable laboratory assays to assess their anticoagulation effect, and the lack of approved antidotes to reverse their action. This article provides an overview of monitoring the anticoagulant effect of NOACs and their potential specific antidotes in development.

Cómo seleccionar el mejor NOAC para los pacientes con fibrilación auricular / How to choose the best NOAC for patients with atrial fibrillation

Los NOAC (No antivitamina K AntiCoagulantes) representan una opción atractiva para numerosos pacientes con fibrilación auricular (FA). Los diversos NOAC tienen propiedades levemente diferentes, por lo que su prescripción debe realizarse en base a las características del paciente. Frente a la necesidad de elegir entre varios NOAC, este artículo ofrece un enfoque centrado en el paciente para seleccionar el mejor NOAC en aquellos con FA no valvular.

A non-Vitamin K antagonist oral anticoagulant (NOAC) is an attractive option for many patients with atrial fibrillation (AF). The various NOACs have slightly different properties, and thus prescribing NOACs should be based on patient characteristics. With several NOACs to choose from, this article offers a patient-centred approach in choosing the best choice of NOACs for non-valvular AF patients.