title: Effects of warfarin therapy on plasma fibrinogen, von Willebrand factor, and fibrin D-dimer in left ventricular dysfunction secondary to coronary artery disease with and without aneurysms.
abstract: Cardiac impairment in patients is associated with intracardiac thrombus formation and thromboembolism. A high prothrombotic state may exist in such patients, and abnormalities in plasma markers of thrombogenesis may be indicative of such a state. The aim of this study was to determine the associations of left ventricular (LV) aneurysm formation and dysfunction with plasma fibrinogen, von Willebrand factor, and fibrin D-dimer, which are markers associated with thrombus formation (thrombogenesis) and to investigate the effects of warfarin given to patients with LV aneurysms on fibrinogen and D-dimer levels. A cross-sectional study of 112 patients with coronary artery disease was initially performed: 34 patients had normal LV function (group 1); 30 had LV dysfunction without aneurysm formation (group 2); 29 had LV aneurysms without anticoagulation (group 3a); and 19 patients had LV aneurysms with warfarin therapy (group 3b). Results were compared with 158 population controls from a random population sample. A longitudinal study of 10 patients given warfarin was also performed. In group 1, plasma fibrinogen (median difference 0.36 g/L; p = 0.0009) and von Willebrand factor (median difference 17 IU/dl; p = 0.04) were elevated, whereas plasma D-dimer levels (median difference 23.0 ng/ml; p = 0.001) were lower than those in population control subjects. There were no significant differences in plasma fibrinogen, von Willebrand factor, or D-dimer levels between groups 1 and 2. In group 3a, plasma fibrinogen was elevated when compared with group 1 (median difference 0.6 g/L; p = 0.0001), with a trend toward high von Willebrand factor levels.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, Stobhill General Hospital, Glasgow, Scotland.
authors.forename: G Y
authors.initials: GY
authors.lastname: Lip
authors.forename: G D
authors.initials: GD
authors.lastname: Lowe
authors.forename: M J
authors.initials: MJ
authors.lastname: Metcalfe
authors.forename: A
authors.initials: A
authors.lastname: Rumley
authors.forename: F G
authors.initials: FG
authors.lastname: Dunn
mesh_terms: D000704:Analysis of Variance; D003327:Coronary Disease / Q000097:blood / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D006322:Heart Aneurysm / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006352:Heart Ventricles; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D014859:Warfarin / Q000627:therapeutic use*; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D014859:Warfarin; D005340:Fibrinogen