open access

Vol 17, No 4 (2010)
Original articles
Published online: 2010-07-27
Submitted: 2013-01-14
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Activation of the endogenous coagulation system in patients with atrial flutter: Relationship to echocardiographic markers of thromboembolic risk

Ganesh S. Kamath, Bengt Herweg, Delia Cotiga, Walter Pierce, Alice J. Cohen, Farooq A. Chaudhry, Michele L. Drejka, Jonathan S. Steinberg
Cardiol J 2010;17(4):390-396.

open access

Vol 17, No 4 (2010)
Original articles
Published online: 2010-07-27
Submitted: 2013-01-14

Abstract

Background: Atrial thrombus formation in patients with atrial flutter raises concerns of stroke risk. We investigated patients with isthmus-dependent atrial flutter for coagulation abnormalities before and after cardioversion to sinus rhythm by catheter ablation, and evaluated the relationship of the abnormalities to the echocardiographic risk markers of stroke.
Methods and results: Plasma samples were drawn prior to insertion of catheters, immediately after the procedure, and 24 hours afterwards. At baseline, coagulation abnormalities were found in 22 out of 25 patients (88%). von Willebrand factor antigen (vWF-Ag) and factor VIII:C were elevated in 17 patients (68%) and 15 patients (60%), respectively. At baseline, mean plasma levels of vWF-Ag (250.1 ± 144.4%) and factor VIII:C (215.0 ± 77.1%) were increased. Key markers of thrombin generation, thrombin-antithrombin III complex (TAT; 47.8 ± 30.9 μg/L vs 14.5 ± 13.8 μg/L; p < 0.05) and prothrombin fragments 1.2 (F1.2; 2.5 ± 0.5 nmoL/L vs 1.2 ± 1.0 nmoL/L) were significantly elevated in the presence of spontaneous echo contrast. Further, both markers of thrombin generation inversely correlated with left atrial appendage emptying velocity (r = -0.42 and -0.63, p < 0.05). Levels of TAT and F1.2 increased after conversion and ablation.
Conclusions: Endothelial-dependent coagulation factors were enhanced in most patients with atrial flutter. Spontaneous echo contrast and decreased atrial contractility were associated with increased thrombin generation. After conversion and ablation, an increase in thrombin generation and fibrinolysis suggest a transient pro-thrombotic state.
(Cardiol J 2010; 17, 4: 390-396)

Abstract

Background: Atrial thrombus formation in patients with atrial flutter raises concerns of stroke risk. We investigated patients with isthmus-dependent atrial flutter for coagulation abnormalities before and after cardioversion to sinus rhythm by catheter ablation, and evaluated the relationship of the abnormalities to the echocardiographic risk markers of stroke.
Methods and results: Plasma samples were drawn prior to insertion of catheters, immediately after the procedure, and 24 hours afterwards. At baseline, coagulation abnormalities were found in 22 out of 25 patients (88%). von Willebrand factor antigen (vWF-Ag) and factor VIII:C were elevated in 17 patients (68%) and 15 patients (60%), respectively. At baseline, mean plasma levels of vWF-Ag (250.1 ± 144.4%) and factor VIII:C (215.0 ± 77.1%) were increased. Key markers of thrombin generation, thrombin-antithrombin III complex (TAT; 47.8 ± 30.9 μg/L vs 14.5 ± 13.8 μg/L; p < 0.05) and prothrombin fragments 1.2 (F1.2; 2.5 ± 0.5 nmoL/L vs 1.2 ± 1.0 nmoL/L) were significantly elevated in the presence of spontaneous echo contrast. Further, both markers of thrombin generation inversely correlated with left atrial appendage emptying velocity (r = -0.42 and -0.63, p < 0.05). Levels of TAT and F1.2 increased after conversion and ablation.
Conclusions: Endothelial-dependent coagulation factors were enhanced in most patients with atrial flutter. Spontaneous echo contrast and decreased atrial contractility were associated with increased thrombin generation. After conversion and ablation, an increase in thrombin generation and fibrinolysis suggest a transient pro-thrombotic state.
(Cardiol J 2010; 17, 4: 390-396)
Get Citation

Keywords

atrial flutter; coagulation; thromboembolic risk; stroke; ablation

About this article
Title

Activation of the endogenous coagulation system in patients with atrial flutter: Relationship to echocardiographic markers of thromboembolic risk

Journal

Cardiology Journal

Issue

Vol 17, No 4 (2010)

Pages

390-396

Published online

2010-07-27

Bibliographic record

Cardiol J 2010;17(4):390-396.

Keywords

atrial flutter
coagulation
thromboembolic risk
stroke
ablation

Authors

Ganesh S. Kamath
Bengt Herweg
Delia Cotiga
Walter Pierce
Alice J. Cohen
Farooq A. Chaudhry
Michele L. Drejka
Jonathan S. Steinberg

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