title: Prolonged activation of hemostatic markers following conversion of atrial flutter to sinus rhythm.
abstract: BACKGROUND
  It remains controversial whether prophylactic anticoagulation for embolism is required in patients with atrial flutter (AFL) prior to and following cardioversion as in patients with atrial fibrillation. To evaluate the potential prothrombotic state following cardioversion of AFL, concentrations of hemostatic markers were determined before and after conversion to sinus rhythm (SR).
  
  
  RESULTS
  In 12 patients (mean age 68 years) with AFL who underwent transesophageal echocardiography in the plasma concentrations of markers for platelet activity (platelet factor 4 (PF4) and beta-thromboglobulin (beta-TG)), thrombotic status (thrombin-antithrombin III complex (TAT) and prothrombin fragments 1 and 2 (F1+2)) and fibrinolytic status (D-dimer and plasmin-alpha(2)-plasmin inhibitor complex (PIC)) were determined during AFL, and 3 days and 7 days after restoration of SR. Left atrial appendage (LAA) blood flow velocity was lower immediately after than before restoration of SR (29+/-11 vs 41+/-23 cm/s, p<0.05). Three patients developed left atrial spontaneous echo contrast immediately after restoration of SR. Although the concentrations of the markers of platelet activity did not change after restoration of SR, those of TAT and PIC increased 7 days after restoration of SR as compared with during AFL (p<0.05).
  
  
  CONCLUSIONS
  AFL patients have a potential risk for thromboembolism after restoration of SR and therefore anticoagulation might be required in selected patients.
authors.affiliation: The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugutani, Toyama 930-0194, Japan
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakurai
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hirai
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kameyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Nozawa
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Asanoi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000368:Aged; D000990:Antithrombin III; D020517:Atrial Appendage / Q000503:physiopathology; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood*; D001783:Blood Flow Velocity; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D005341:Fibrinolysin / Q000378:metabolism; D006339:Heart Rate; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood; D013997:Time Factors; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C037742:plasmin-plasmin inhibitor complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D005341:Fibrinolysin