Association between red cell distribution width and thromboembolic events in patients with atrial fibrillation

Published:August 04, 2017DOI:


      • An association between RDW elevation and thromboembolic risk in AF patients is investigated.
      • Two cut-off points for poor outcome is proposed (generally ≥13.9% and ≥15.5% in heart failure).
      • Patient's clinical risk can be checked again when their RDW level increases during follow-up.



      We investigated whether an increase in the value of red cell distribution width (RDW) was associated with thromboembolic outcomes in patients with atrial fibrillation (AF).


      We performed a retrospective analysis of 5082 consecutive patients with non-valvular AF. Thromboembolic events (N = 723, 14.2%) were recorded and analysed according to RDW value.


      The peak RDW value during follow-up was higher in patients with thromboembolic events than in those without thromboembolic events (15.1% vs. 14.2%, p < 0.001). The RDW value showed similar power in predicting thromboembolic outcomes compared with the factor of age. The risk of thromboembolic events was higher in patients with a peak RDW ≥ 13.9% than in patients with a peak RDW < 13.9% (hazard ratio 1.63, p < 0.001), and increased with each quartile increase of RDW. In a subgroup of 739 patients with congestive heart failure (CHF), there were 112 (15.2%) thromboembolic events. The peak RDW value of patients with CHF with thromboembolic events was also significantly higher (16.4% vs. 15.6%, p = 0.019) compared to that of those without thromboembolic events.


      An increased RDW value during follow-up could be associated with thromboembolic events in patients with non-valvular AF. The suggested cut-off values for RDW used to predict an increased thromboembolic risk in were ≥13.9% in patients with AF in general, ≥15% in patients with co-existing AF and CHF.


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