Decreased Activity of the Protein C Anticoagulant Pathway in the Early Hours of Paroxysmal Atrial Fibrillation.
BACKGROUND
Increased coagulation activity has been established in paroxysmal atrial fibrillation (PAF), but data on the anticoagulant system are scarce.


OBJECTIVE
To examine the protein C anticoagulant pathway in the early hours of the disease.


METHODS
Fifty-one patients (26 men and 25 women; mean age 59.84 ± 1.60 years) and 52 controls (26 men and 26 women; mean age 59.50 ± 1.46 years) were selected for the study. Protein C antigen and its activity, total protein S, free protein S and its activity, soluble forms of endothelial protein C receptor (sEPCR), and thrombomodulin (sTM) were examined in the plasma.


RESULTS
The indicators were studied in patients between the 2nd and the 24th hour after the onset of arrhythmia. Levels of protein C were significantly elevated in patients compared to controls (111.40% ± 6.66% vs 94.83% ± 4.47%; P = .039). Protein C activity showed significant reduction in PAF (73.13% ± 5.80% vs 103.3% ± 3.80%; P < .001). Total protein S levels did not differ significantly (108.20% ± 4.07% vs 102.40% ± 3.65%; P = .30). Free protein S (76.81% ± 6.01% vs 122.10% ± 3.97%; P < .001) and its activity (71.39% ± 6.27% vs 119.50% ± 6.54%; P < .001) were reduced in patients. Higher levels of sEPCR (203.10 ± 10.33 vs 133.10 ± 7.37 ng/mL; P < .001) and sTM (6.50±0.40 vs 4.48±0.28 ng/mL; P < .001) were measured in PAF.


CONCLUSIONS
Protein C activity is reduced still in the first hours (until the 24th hour) of PAF clinical manifestation, determining reduced activity of the anticoagulant pathway as a whole. The established low levels of free protein S and its activity as well as low sEPCR and sTM levels are a possible explanation of the changes in protein C activity.
1 First Clinic of Cardiology, Varna University Hospital "St. Marina," Varna, Bulgaria.
Mariya
M
Negreva
2 Second Clinic of Cardiology, Varna University Hospital "St. Marina," Varna, Bulgaria.
Svetoslav
S
Georgiev
3 Clinic of Cardiology, Second City Hospital of Sofia, Sofia, Bulgaria.
Katerina
K
Vitlianova
D000925:Anticoagulants / Q000378:metabolism; D001281:Atrial Fibrillation / Q000097:blood*; D000074283:Endothelial Protein C Receptor / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000032:analysis / Q000378:metabolism*; D017293:Protein S / Q000032:analysis; D018180:Thrombomodulin / Q000097:blood; D013997:Time Factors
D000925:Anticoagulants; D000074283:Endothelial Protein C Receptor; C478370:PROCR protein, human; D011486:Protein C; D017293:Protein S; C546931:THBD protein, human; D018180:Thrombomodulin
paroxysmal atrial fibrillation; protein C; protein C anticoagulant pathway; protein S; soluble endothelial protein C receptor; soluble thrombomodulin