title: Hypercoagulability and chronic atrial fibrillation: the role of markers of thrombin generation.
abstract: BACKGROUND
  We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalvular atrial fibrillation (AF). Patients were also stratified according to a history of prior stroke.
  
  
  METHODS
  The generation of thrombin was investigated by means of the molecular markers prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), because AF patients may have a hypercoagulable state. There was only a trend toward higher values of TAT and F1 + 2 for AF patients, while subjects with previous stroke (irrespective of AF) had increased levels of the markers of thrombin generation (TAT stroke+ 18.95 +/- 5.15 vs TAT stroke- 8.34 +/- 2.41; F1 + 2 stroke+ 2.22 +/- 0.29 vs F1 + 2 stroke- 1.32 +/- 0.12). The presence of spontaneous echo contrast (SEC) within left atrium was also investigated in 32 AF patients by transesophageal echocardiography.
  
  
  RESULTS
  TAT were significantly higher in subjects (n = 11) with SEC (TAT sec+ 37.5 +/- 13.41 vs TAT sec- 8.7 +/- 2.51, p = 0.008).
  
  
  CONCLUSIONS
  Finally, when we grouped into 1) those with both AF and stroke, 2) AF alone, 3) stroke alone and 4) sinus rhythm without stroke, levels of F1 + 2 were higher (and marginally higher TAT) in patients with AF and stroke than in those without stroke, revealing that there is a true clotting activation state in these subjects.
authors.affiliation: 4th Medical Department, San Carlo Borromeo General Hospital, Milan.
authors.forename: M
authors.initials: M
authors.lastname: Soncini
authors.forename: F
authors.initials: F
authors.lastname: Casazza
authors.forename: R
authors.initials: R
authors.lastname: Mattioli
authors.forename: C
authors.initials: C
authors.lastname: Bonfardeci
authors.forename: A
authors.initials: A
authors.lastname: Motta
authors.forename: C
authors.initials: C
authors.lastname: Cimminiello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000032:analysis*; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000209:etiology; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis; D001780:Blood Coagulation Tests; D002561:Cerebrovascular Disorders / Q000097:blood / Q000150:complications; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D010447:Peptide Hydrolases / Q000032:analysis*; D011516:Prothrombin / Q000032:analysis; D013917:Thrombin / Q000378:metabolism*
chemical_list: D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases; D013917:Thrombin