title: Predictive Role of Coagulation, Fibrinolytic, and Endothelial Markers in Patients with Atrial Fibrillation, Stroke, and Thromboembolism: A Meta-Analysis, Meta-Regression, and Systematic Review.
abstract: BACKGROUND The pathophysiological mechanism associated with the higher prothrombotic tendency in atrial fibrillation (AF) is complex and multifactorial. However, the role of prothrombotic markers in AF remains inconclusive. MATERIAL AND METHODS We conducted a meta-analysis of observational studies evaluating the association of coagulation activation, fibrinolytic, and endothelial function with occurrence of AF and clinical adverse events. A comprehensive subgroup analysis and meta-regression was performed to explore potential sources of heterogeneity. RESULTS A literature search of major databases retrieved 1703 studies. After screening, a total of 71 studies were identified. Pooled analysis showed the association of coagulation markers (D-dimer (weighted mean difference (WMD) =197.67 and p<0.001), fibrinogen (WMD=0.43 and p<0.001), prothrombin fragment 1-2 (WMD=0.53 and p<0.001), antithrombin III (WMD=23.90 and p=0.004), thrombin-antithrombin (WMD=5.47 and p=0.004));  fibrinolytic markers (tissue-type plasminogen activator (t-PA) (WMD=2.13 and p<0.001), plasminogen activator inhibitor (WMD=11.44 and p<0.001), fibrinopeptide-A (WMD=4.13 and p=0.01)); and  endothelial markers (von Willebrand factor (WMD=27.01 and p<0.001) and soluble thrombomodulin (WMD=3.92 and p<0.001)) with AF. CONCLUSIONS The levels of coagulation, fibrinolytic, and endothelial markers have been reported to be significantly higher in AF patients than in SR patients.
authors.affiliation: Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom.|Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Sadeq
authors.initials: S
authors.lastname: Ali-Hasan-Al-Saegh
authors.affiliation: Department of Cardiac Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Seyed
authors.initials: S
authors.lastname: Jalil Mirhosseini
authors.affiliation: , University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Baker
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Lotfaliani
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, 2nd Hospital of Tianjin Medical University, Tianjin, China (mainland).
authors.forename: Tong
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Health Technology Assessment, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Dehghan
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
authors.forename: Senol
authors.initials: S
authors.lastname: Yavuz
authors.affiliation: Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.|, University of Pernambuco - UPE, Recife, Brazil.|, Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife, Brazil.
authors.forename: Michel Pompeu Barros
authors.initials: MP
authors.lastname: de Oliveira Sá
authors.affiliation: Department of Cardiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield Middlesex, United Kingdom.|Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, 2nd Hospital of Tianjin Medical University, Tianjing, China (mainland).
authors.forename: Lei
authors.initials: L
authors.lastname: Meng
authors.affiliation: Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Mayo Clinic Heart Rhythm Section, Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Abhishek J
authors.initials: AJ
authors.lastname: Deshmukh
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.affiliation: Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: 0, 0.
authors.forename: Integrated Meta-Analysis Of Cardiac
authors.initials: IM
authors.lastname: Cardiac Surgery And Cardiology-Group Imcsc-Group
mesh_terms: D001281:Atrial Fibrillation / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000378:metabolism*; D006801:Humans; D020521:Stroke / Q000097:blood* / Q000150:complications; D013923:Thromboembolism / Q000097:blood*; D010959:Tissue Plasminogen Activator / Q000097:blood
chemical_list: D015415:Biomarkers; D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator
keywords: Atrial Fibrillation; Blood Coagulation Disorders; Fibrinolysis