title: Detection of a hypercoagulable state in nonvalvular atrial fibrillation and the effect of anticoagulant therapy.
abstract: The purpose of the study was to evaluate alterations of the hemostatic system and the effect of anticoagulant therapy in nonvalvular atrial fibrillation. A set of molecular hematologic markers was measured prospectively in 69 patients with atrial fibrillation and 28 age-matched patients in sinus rhythm. Significantly elevated levels of thrombin-antithrombin III complex (8.5 +/- 1.6 vs. 2.5 +/- 0.3 micrograms/l; p < 0.001), fibrin monomers (27.1 +/- 3.2 vs. 13.4 +/- 3.7 nM; p < 0.001), D-dimers (788 +/- 76 vs. 405 +/- 46 micrograms/l; p < 0.005), and tissue-type plasminogen activator (9.6 +/- 0.5 vs. 7.2 +/- 0.5 micrograms/l; p < 0.05) were observed in patients with atrial fibrillation compared to those in sinus rhythm. In a subgroup of patients in whom anticoagulant therapy with oral coumadin or standard intravenous heparin was established after the initial study, hemostatic activation decreased significantly. In conclusion, molecular hematologic markers indicate a hypercoagulable state in atrial fibrillation which may characterized a group of patients at elevated risk of thromboembolic disease.
authors.affiliation: Department of Cardiology, Medical University of Lübeck, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Mitusch
authors.forename: H J
authors.initials: HJ
authors.lastname: Siemens
authors.forename: M
authors.initials: M
authors.lastname: Garbe
authors.forename: T
authors.initials: T
authors.lastname: Wagner
authors.forename: A
authors.initials: A
authors.lastname: Sheikhzadeh
authors.forename: K W
authors.initials: KW
authors.lastname: Diederich
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D000990:Antithrombin III / Q000032:analysis; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D015415:Biomarkers; D001777:Blood Coagulation / Q000187:drug effects; D001798:Blood Proteins / Q000032:analysis*; D017548:Echocardiography, Transesophageal; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging; D010314:Partial Thromboplastin Time; D010446:Peptide Fragments / Q000032:analysis; D010447:Peptide Hydrolases / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis; D012306:Risk; D013923:Thromboembolism / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014859:Warfarin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D001798:Blood Proteins; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D017395:Plasminogen Activator Inhibitor 1; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D014859:Warfarin; D000990:Antithrombin III; D011516:Prothrombin; D005337:Fibrin; D006493:Heparin; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator; D001241:Aspirin