Hypercoagulability and chronic atrial fibrillation: the role of markers of thrombin generation.
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.
Soncini
M
M
4th Medical Department, San Carlo Borromeo General Hospital, Milan.
Casazza
F
F
Mattioli
R
R
Bonfardeci
C
C
Motta
A
A
Cimminiello
C
C
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*
D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases; D013917:Thrombin