Coagulation, fibrinolytic system activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm.
Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p < 0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p < 0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p < 0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p < 0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.
Topaloglu
Serkan
S
Department of Cardiology, Ankara Turkiye Yuksek Ihtisas Hospital, 06100 Sihhiye, Ankara, Turkey. topaloglus@hotmail.com
Boyaci
Ayca
A
Ayaz
Selime
S
Yilmaz
Sevinç
S
Yanik
Oya
O
Ozdemir
Ozcan
O
Soylu
Mustafa
M
Demir
Ahmet Duran
AD
Aras
Dursun
D
Kisacik
Halil Lutfi
HL
Korkmaz
Sule
S
D000328:Adult; D000990:Antithrombin III / Q000032:analysis*; D001281:Atrial Fibrillation / Q000097:blood* / Q000503:physiopathology; D001779:Blood Coagulation Factors / Q000032:analysis*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000097:blood* / Q000503:physiopathology; D011651:Pulmonary Artery / Q000503:physiopathology
D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D000990:Antithrombin III