Document Detail


Activation of the endogenous coagulation system in patients with atrial flutter: relationship to echocardiographic markers of thromboembolic risk.
MedLine Citation:
PMID:  20690096     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Cardiology journal     Volume:  17     ISSN:  1897-5593     ISO Abbreviation:  Cardiol J     Publication Date:  2010  
Date Detail:
Created Date:  2010-08-06     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101392712     Medline TA:  Cardiol J     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  390-6     Citation Subset:  IM    
Affiliation:
Division of Cardiology, St. Luke's and Roosevelt Hospitals, 1111 Amsterdam Avenue, New York, NY 10025, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
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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