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

Year 2020, Volume: 47 Issue: 1, 24 - 33, 17.03.2020
https://doi.org/10.5798/dicletip.705814

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.

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.
Year 2020, Volume: 47 Issue: 1, 24 - 33, 17.03.2020
https://doi.org/10.5798/dicletip.705814

Abstract

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.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Articles
Authors

Kahraman Cosansu This is me

Cagın Mustafa Ureyen This is me

Harun Kılıc This is me

Bilgehan Karadag This is me

Aycaturer Cabbar This is me

Huseyin Gunduz This is me

Ramazan Akdemir This is me

Publication Date March 17, 2020
Submission Date August 5, 2019
Published in Issue Year 2020 Volume: 47 Issue: 1

Cite

APA Cosansu, K., Ureyen, C. M., Kılıc, H., Karadag, B., 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
AMA 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. diclemedj. March 2020;47(1):24-33. doi:10.5798/dicletip.705814
Chicago Cosansu, Kahraman, Cagın Mustafa Ureyen, Harun Kılıc, Bilgehan Karadag, Aycaturer Cabbar, Huseyin Gunduz, and Ramazan Akdemir. “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients With Nonvalvular Atrial Fibrillation: A Pilot Study”. Dicle Medical Journal 47, no. 1 (March 2020): 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 K. Cosansu, C. M. Ureyen, H. Kılıc, B. Karadag, A. Cabbar, H. Gunduz, and R. Akdemir, “New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study”, diclemedj, vol. 47, no. 1, pp. 24–33, 2020, doi: 10.5798/dicletip.705814.
ISNAD 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 47/1 (March 2020), 24-33. https://doi.org/10.5798/dicletip.705814.
JAMA 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. diclemedj. 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, 2020, pp. 24-33, doi:10.5798/dicletip.705814.
Vancouver 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. diclemedj. 2020;47(1):24-33.