| Activation of the endogenous coagulation system in patients with atrial flutter: relationship to echocardiographic markers of thromboembolic risk. | |
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MedLine Citation:
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PMID: 20690096 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Atrial thrombus formation in patients with atrial flutter raises concerns of stroke risk. We investigated patients with isthmus-dependent atrial flutter for coagulation abnormalities before and after cardioversion to sinus rhythm by catheter ablation, and evaluated the relationship of the abnormalities to the echocardiographic risk markers of stroke. METHODS AND RESULTS: Plasma samples were drawn prior to insertion of catheters, immediately after the procedure, and 24 hours afterwards. At baseline, coagulation abnormalities were found in 22 out of 25 patients (88%). von Willebrand factor antigen (vWF-Ag) and factor VIII:C were elevated in 17 patients (68%) and 15 patients (60%), respectively. At baseline, mean plasma levels of vWF-Ag (250.1 +/- 144.4%) and factor VIII:C (215.0 +/- 77.1%) were increased. Key markers of thrombin generation, thrombin-antithrombin III complex (TAT; 47.8 +/- 30.9 microg/L vs 14.5 +/- 13.8 microg/L; p < 0.05) and prothrombin fragments 1.2 (F1.2; 2.5 +/- 0.5 nmoL/L vs 1.2 +/- 1.0 nmoL/L) were significantly elevated in the presence of spontaneous echo contrast. Further, both markers of thrombin generation inversely correlated with left atrial appendage emptying velocity (r = -0.42 and -0.63, p < 0.05). Levels of TAT and F1.2 increased after conversion and ablation. CONCLUSIONS: Endothelial-dependent coagulation factors were enhanced in most patients with atrial flutter. Spontaneous echo contrast and decreased atrial contractility were associated with increased thrombin generation. After conversion and ablation, an increase in thrombin generation and fibrinolysis suggest a transient pro-thrombotic state. |
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Authors:
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Ganesh S Kamath; Bengt Herweg; Delia Cotiga; Walter Pierce; Alice J Cohen; Farooq A Chaudhry; Michele L Drejka; Jonathan S Steinberg |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Cardiology journal Volume: 17 ISSN: 1897-5593 ISO Abbreviation: Cardiol J Publication Date: 2010 |
Date Detail:
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Created Date: 2010-08-06 Completed Date: 2010-11-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101392712 Medline TA: Cardiol J Country: Poland |
Other Details:
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Languages: eng Pagination: 390-6 Citation Subset: IM |
Affiliation:
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Division of Cardiology, St. Luke's and Roosevelt Hospitals, 1111 Amsterdam Avenue, New York, NY 10025, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Antithrombin III Atrial Fibrillation / blood, complications*, surgery, ultrasonography Biological Markers / blood Blood Coagulation* Catheter Ablation* / adverse effects Echocardiography, Doppler, Pulsed* Echocardiography, Transesophageal* Factor VIII / metabolism Female Humans Logistic Models Male Middle Aged Peptide Fragments / blood Peptide Hydrolases / blood Prothrombin Risk Assessment Risk Factors Stroke / blood, etiology* Thrombin / metabolism Thromboembolism / blood, etiology* Treatment Outcome United States von Willebrand Factor / metabolism |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Peptide Fragments; 0/antithrombin III-protease complex; 0/prothrombin fragment 1.2; 0/von Willebrand Factor; 9000-94-6/Antithrombin III; 9001-26-7/Prothrombin; 9001-27-8/Factor VIII; EC 3.4.-/Peptide Hydrolases; EC 3.4.21.5/Thrombin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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