New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study

Kahraman Cosansu; Cagın Mustafa Ureyen; Harun Kılıc; Bilgehan Karadag; Aycaturer Cabbar; Huseyin Gunduz; Ramazan Akdemir

doi:10.5798/dicletip.705814

New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study

Abstract

Objective: The primary aim of this study was to investigate the role of platelet-lymphocyte ratio (PLR) to predict bleeding risk in nonvalvular atrial fibrillation (NVAF). Secondary aim was to determine the possible relation between PLR and thromboembolic and bleeding risk scores. Tertiary aim was to evaluate the predictive value of PLR for the patients in the therapeutic international normalized ratio (INR) range. Method: PLR was calculated from the complete blood count of 228 patients who were under warfarin management for NVAF. The patients were called and it was questioned whether they had experienced the bleeding event within six months after measurement of the PLR values. Results: Bleeding event was observed in 48 patients after the PLR was calculated. It was found significantly correlation between PLR and CHA2DVAS2C (p<0.01) and HAS-BLED score (p<0,001). The ROC analysis showed that PLR predicted bleeding with a sensitivity of 83% and with a specificity of 84%, using a cut-off value of 165,9. The AUC (area under the curve) for the PLR was found 0.88 (p<0.001). PLR predicted the patients in therapeutic INR range with a sensitivity of 75% at ROC analysis, when using a cut-off value of 125,3 and AUC for the PLR was 0.73 (p<0.001). In the multivariate regression analysis, PLR>165,9 was determined significant indicator for bleeding (p<0.001) and showed more than a 12-fold increased risk of bleeding (12.27, [5.74-26.21]). Conclusions: The results of the present study indicate that the PLR might be a useful parameter to detect the risk of bleeding. To our knowledge, this is the first study demonstrating the correlation of PLR with both CHA2DS2-VASc and HAS-BLED risk scores. PLR may also predict the patients within the therapeutic INR range.

Keywords

Platelet-Lymphocyte Ratio,Bleeding Risk

References

1. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996; 27: 1760–4.
2. Hart RG, Pearce LA, Aguilar MI. Meta‐analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146: 857–67.
3. Zareh M, Davis A, Henderson S. Reversal of warfarin-induced hemorrhage in the emergency department. West J Emerg Med. 2011; 12: 386–92.
4. Beyth RJ, Quinn LM, Landefeld CS. Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med. 1998; 105: 91–9.
5. Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33: 2719–47.
6. Watson T, Shantsila E, Lip G.Y. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009; 373: 155-66.
7. Prage P, Hisham D, Peter T, et al. Update on the association of inflammation and atrial fibrillation. J CardiovascElectrophysiol. 2010; 21: 1064-70.
8. Turkmen K, Erdur FM, Ozcicek F, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013; 17: 391-6.

9. Turkmen K. Platelet-to-Lymphocyte Ratio: One of the novel and valuable platelet indices in hemodialysis patients. Hemodial Int. 2013; 17: 670.
10. Akboga MK, Canpolat U, Balci KG, et al. Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow. Angiology. 2016; 67: 21-6.
11. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am CollCardiol. 2014; 64: e1–e76.
12. Friedrichs K., Klinke A., Baldus S. Inflammatory pathways underlying atrial fibrillation. Trend Molec Med. 2011; 17: 556-63.
13. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005; 115: 3378–84.
14. Lindemann S, Krämer B, Seizer P, et al. Platelets, inflammation and atherosclerosis. J ThrombHaemost. 2007; 5: 203–11
15. Gary T, Pichler M, Belaj K, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013; 8: 676–88.
16. Davi G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007; 357: 2482–94.
17. Ly HQ, Kirtane AJ, Murphy SA, et al. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). Am J Cardiol. 2006; 98: 1–5.
18. Slavka G, Perkmann T, Haslacher H, et al. Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. ArteriosclerThrombVasc Biol. 2011; 31: 1215–8.
19. Zou Y, Zhang W, Huang C, Zhu Y. Clinical significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in acute cerebral hemorrhage with gastrointestinal hemorrhage, and logistic regression analysis of risk factors. ExpTher Med. 2019; 18: 1533-8.
20. Aksakal C, Şahin M. Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study. Pan Afr Med J. 2019; 32: 154.
21. Gayret OB, Erol M, TekinNacaroglu H. The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Gastrointestinal Bleeding in Henoch-Schonlein Purpura. Iran J Pediatr. 2016; 26: e8191.
22. Şaşkın H, Düzyol Ç, Özcan KS, et al. Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting. Heart Surg Forum. 2015; 18: E255-62.
23. Altintas O, Tasal A, Niftaliyev E, et al. Association of platelet-to-lymphocyte ratio with silent brain infarcts in patients with paroxysmal atrial fibrillation. Neurol Res. 2016; 21: 1-6.
24. Monteiro JMC, San-Martin DL, Silva BCG, et al. Dabigatran and warfarin in nonvalvular atrial fibrillation or atrial flutter in outpatient clinic practice in Brazil. ArqNeuropsiquiatr. 2019; 77: 80-3.
25. Ozturk M, Ipekci A, Kiyak SK, et al. Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department. J Clin Med Res. 2019; 11: 106-13.
26. Ng DL, Gan GG, Chai CS, et al. Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants: a cross-sectional study. Patient Prefer Adherence. 2019; 13: 1363-73.
27. Akdag S, Simsek H, Sahin M, et al. Association of epicardial adipose tissue thickness and inflammation parameters with CHA2DS2-VASASc score in patients with nonvalvular atrial fibrillation. TherClin Risk Manag. 2015; 11: 1675-81.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Kahraman Cosansu ^* This is me
Türkiye

Cagın Mustafa Ureyen This is me
Türkiye

Harun Kılıc This is me
Türkiye

Bilgehan Karadag This is me
Türkiye

Aycaturer Cabbar This is me
Türkiye

Huseyin Gunduz This is me
Türkiye

Ramazan Akdemir This is me
Türkiye

Publication Date

March 17, 2020

Submission Date

August 5, 2019

Acceptance Date

January 7, 2020

Published in Issue

Year 2020 Volume: 47 Number: 1

DOI

https://doi.org/10.5798/dicletip.705814

IZ

https://izlik.org/JA42KD97EC

Cite

RIS / Bibtex

APA

Cosansu, K., Ureyen, C. M., Kılıc, H., Karadag, B., Cabbar, A., Gunduz, H., & Akdemir, R. (2020). New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study. Dicle Medical Journal, 47(1), 24-33. https://doi.org/10.5798/dicletip.705814

AMA

1.Cosansu K, Ureyen CM, Kılıc H, et al. New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study. Dicle Medical Journal. 2020;47(1):24-33. doi:10.5798/dicletip.705814

Chicago

Cosansu, Kahraman, Cagın Mustafa Ureyen, Harun Kılıc, et al. 2020. “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients With Nonvalvular Atrial Fibrillation: A Pilot Study”. Dicle Medical Journal 47 (1): 24-33. https://doi.org/10.5798/dicletip.705814.

EndNote

Cosansu K, Ureyen CM, Kılıc H, Karadag B, Cabbar A, Gunduz H, Akdemir R (March 1, 2020) New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study. Dicle Medical Journal 47 1 24–33.

IEEE

[1]K. Cosansu et al., “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study”, Dicle Medical Journal, vol. 47, no. 1, pp. 24–33, Mar. 2020, doi: 10.5798/dicletip.705814.

ISNAD

Cosansu, Kahraman - Ureyen, Cagın Mustafa - Kılıc, Harun - Karadag, Bilgehan - Cabbar, Aycaturer - Gunduz, Huseyin - Akdemir, Ramazan. “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients With Nonvalvular Atrial Fibrillation: A Pilot Study”. Dicle Medical Journal 47/1 (March 1, 2020): 24-33. https://doi.org/10.5798/dicletip.705814.

JAMA

1.Cosansu K, Ureyen CM, Kılıc H, Karadag B, Cabbar A, Gunduz H, Akdemir R. New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study. Dicle Medical Journal. 2020;47:24–33.

MLA

Cosansu, Kahraman, et al. “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients With Nonvalvular Atrial Fibrillation: A Pilot Study”. Dicle Medical Journal, vol. 47, no. 1, Mar. 2020, pp. 24-33, doi:10.5798/dicletip.705814.

Vancouver

1.Kahraman Cosansu, Cagın Mustafa Ureyen, Harun Kılıc, Bilgehan Karadag, Aycaturer Cabbar, Huseyin Gunduz, Ramazan Akdemir. New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study. Dicle Medical Journal. 2020 Mar. 1;47(1):24-33. doi:10.5798/dicletip.705814

Cited By

Hematological parameters in atrial fibrillation: A literature review

World Journal of Cardiology

https://doi.org/10.4330/wjc.v17.i7.108363