[Improvement in fibrinolytic function following anticoagulant treatment in chronic rheumatic atrial fibrillation].
OBJECTIVE
Patients with rheumatic atrial fibrillation are considered at high risk of systemic embolism and require oral anticoagulation. Fibrinolytic function has been little studied. We evaluated fibrinolytic activation markers before starting anticoagulation, at 1 and 6 months following the introduction of oral anticoagulation therapy. We analyzed the relationship with left atrial diameter and mitral area.


METHODS
Tissue plasminogen activator (tPA), its inhibitor (PAI-1), plasmin-antiplasmin complexes (PAP) and D-dimer were measured in 13 patients with rheumatic atrial fibrillation. Basal levels were compared with those found in plasma of 20 healthy subjects matched by sex and age. Transthoracic echocardiography was made.


RESULTS
A significant increase for PAI-1 and D-dimer levels were detected in patients with atrial fibrillation group (p < 0.05), with no differences in tPA and PAP concentrations. Significant correlation between left atrial diameter and basal t-PA levels was found. Levels of t-PA, PAI-1 and D-dimer decreased significantly under anticoagulation therapy, whereas PAP levels were significantly increased.


CONCLUSIONS
Patients with rheumatic atrial fibrillation show a relative hypofibrinolytic state due to elevated PAI-1 levels with no increase in PAP concentration. At six months of anticoagulation therapy, an improvement of fibrinolytic function markers was observed. This is consistent with the prophylactic effect of oral anticoagulants therapy against thromboembolic risk.
Marín Ortuño
F
F
Sección de Cardiología, Hospital General Universitario de Elche, Alicante.
Roldán Schilling
V
V
Marco Vera
P
P
Martínez Martínez
J G
JG
Toral Noguera
A
A
García de Burgos Rico
F
F
Calatayud Sendra
R
R
Sogorb Garri
F
F
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D012214:Rheumatic Heart Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D013997:Time Factors