{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:28:03Z","timestamp":1790962083670,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Thrombocytopenia is associated with increased mortality in the general population, but few data exist in patients with atrial fibrillation (\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              ) taking oral anticoagulants. We investigated factor determinants of thrombocytopenia in a large cohort of patients affected by\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              and its association with total mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Multicenter prospective cohort study, including 5215 patients with AF from the\n              <jats:styled-content style=\"fixed-case\">START<\/jats:styled-content>\n              (Survey on Anticoagulated Patients Register) registry, 3877 (74.3%) and 1338 (25.7%) on vitamin K or non\u2013vitamin K antagonist oral anticoagulants, respectively. Thrombocytopenia was defined by a platelet count &lt;150\u00d710\n              <jats:sup>9<\/jats:sup>\n              \/L. Determinants of thrombocytopenia were investigated, and all\u2010cause mortality was the primary survival end point of the study. Thrombocytopenia was present in 592 patients (11.4%). At multivariable logistic regression analysis, chronic kidney disease (odds ratio [\n              <jats:styled-content style=\"fixed-case\">OR],<\/jats:styled-content>\n              1.257;\n              <jats:italic>P<\/jats:italic>\n              =0.030), active cancer (\n              <jats:styled-content style=\"fixed-case\">OR,<\/jats:styled-content>\n              2.065;\n              <jats:italic>P<\/jats:italic>\n              =0.001), liver cirrhosis (\n              <jats:styled-content style=\"fixed-case\">OR,<\/jats:styled-content>\n              7.635;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and the use of diuretics (\n              <jats:styled-content style=\"fixed-case\">OR,<\/jats:styled-content>\n              1.234;\n              <jats:italic>P<\/jats:italic>\n              =0.046) were positively associated with thrombocytopenia, whereas female sex (\n              <jats:styled-content style=\"fixed-case\">OR,<\/jats:styled-content>\n              0.387;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and the use of calcium channel blockers (\n              <jats:styled-content style=\"fixed-case\">OR,<\/jats:styled-content>\n              0.787;\n              <jats:italic>P<\/jats:italic>\n              =0.032) were negatively associated. During a median follow\u2010up of 19.2\u00a0months (9942 patient\u2010years), 391 deaths occurred (rate, 3.93%\/year). Mortality rate increased from 3.8%\/year to 9.9%\/year in patients with normal platelet count and in those with moderate\u2010severe thrombocytopenia, respectively (log\u2010rank test,\n              <jats:italic>P<\/jats:italic>\n              =0.009). The association between moderate\u2010severe thrombocytopenia and mortality persisted after adjustment for\n              <jats:styled-content style=\"fixed-case\">CHA<\/jats:styled-content>\n              <jats:sub>2<\/jats:sub>\n              <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content>\n              <jats:sub>2<\/jats:sub>\n              <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content>\n              c score (hazard ratio, 2.431; 95% CI, 1.254\u20134.713;\n              <jats:italic>P<\/jats:italic>\n              =0.009), but not in the fully adjusted multivariable Cox regression analysis model.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Thrombocytopenia is common in patients with\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              . Despite an increased incidence of mortality, thrombocytopenia was not associated with mortality at multivariable analysis. Thrombocytopenia may reflect the presence of comorbidities associated with poor survival in\n              <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012596","type":"journal-article","created":{"date-parts":[[2019,10,28]],"date-time":"2019-10-28T09:00:12Z","timestamp":1572253212000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Thrombocytopenia and Mortality Risk in Patients With Atrial Fibrillation: An Analysis From the START Registry"],"prefix":"10.1161","volume":"8","author":[{"given":"Daniele","family":"Pastori","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Medical Specialties I Clinica Medica Atherothrombosis Centre Sapienza University of Rome Rome 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