Detection of a Hypercoagulable State in Nonvalvular Atrial Fibrillation and the Effect of Anticoagulant Therapy

1996 ◽  
Vol 75 (02) ◽  
pp. 219-223 ◽  
Author(s):  
Rolf Mitusch ◽  
Hans J Slemens ◽  
Michael Garbe ◽  
Thomas Wagner ◽  
Abdolhamid Sheikhzadeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Anticoagulant Therapy ◽  
Initial Study ◽  
Hypercoagulable State ◽  
Tissue Type ◽  
Nonvalvular Atrial Fibrillation ◽  
Type Plasminogen Activator ◽  
Intravenous Heparin ◽  
Thrombin Antithrombin Iii Complex

SummaryThe purpose of the study was to evaluate alterations of the hemostatic system and the effect of anticoagulant therapy in nonvalvular atrial fibrillation. A set of molecular hematologic markers was measured prospectively in 69 patients with atrial fibrillation and 28 age-matched patients in sinus rhythm. Significantly elevated levels of thrombin-antithrombin III complex (8.5 ± 1.6 vs. 2.5 ± 0.3 αg/1; p <0.001), fibrin monomers (27.1 ± 3.2 vs. 13.4 ± 3.7 nM; p <0.001), D-dimers (788 ± 76 vs. 405 ± 46 αg/l; p <0.005), and tissue-type plasminogen activator (9.6 ± 0.5 vs. 7.2 ± 0.5 αg/l; p <0.05) were observed in patients with atrial fibrillation compared to those in sinus rhythm. In a subgroup of patients in whom anticoagulant therapy with oral coumadin or standard intravenous heparin was established after the initial study, hemostatic activation decreased significantly. In conclusion, molecular hematologic markers indicate a hypercoagulable state in atrial fibrillation which may characterize a group of patients at elevated risk for thromboembolic disease.

scholarly journals Plasma antigen levels of the lipoprotein-associated coagulation inhibitor in patient samples

Blood ◽  
1991 ◽  
Vol 78 (2) ◽  
pp. 387-393 ◽  
Author(s):  
WF Novotny ◽  
SG Brown ◽  
JP Miletich ◽  
DJ Rader ◽  
GJ Jr Broze
Keyword(s):  
Mean Value ◽  
Tissue Type ◽  
Extrinsic Pathway ◽  
Type Plasminogen Activator ◽  
Intravenous Heparin ◽  
Normal Individuals ◽  
Coagulation Inhibitor ◽  
Gram Negative Bacteremia ◽  
Heparin Plasma ◽  
Low Levels

Abstract Human plasma contains an inhibitor of tissue factor-initiated coagulation known as the lipoprotein-associated coagulation inhibitor (LACI) or also known as the extrinsic pathway inhibitor (EPI). A competitive fluorescent immunoassay was developed to measure the plasma concentration of LACI in samples from normal individuals and patients with a variety of diseases. The LACI concentration in an adult control population varied from 60% to 160% of the mean with a mean value corresponding to 89 ng/mL or 2.25 nmol/L. Plasma LACI levels were not decreased in patients with severe chronic hepatic failure, warfarin therapy, primary pulmonary hypertension, thrombosis, or the lupus anticoagulant. Plasma LACI antigen was decreased in some, but not all patients with gram-negative bacteremia and evidence for disseminated intravascular coagulation. Plasma LACI levels were elevated in women undergoing the early stages of labor (29%), in patients receiving intravenous tissue-type plasminogen activator (45%), and in patients receiving intravenous heparin (375%). A radioligand blot of the pre- and post-heparin plasma samples shows the increase to be in a 40-Kd form of LACI. Very low levels of plasma LACI antigen were found in patients with homozygous abetalipoproteinemia and hypobetalipoproteinemia, diseases associated with low plasma levels of apolipoprotein B containing lipoproteins. Following the injection of heparin into one patient with homozygous abetalipoproteinemia, the plasma LACI antigen level increased to a level comparable with that in normal individuals after heparin treatment.

scholarly journals Optimal choice of prophylactic anticoagulant therapy for nonvalvular atrial fibrillation in the context of COVID-19 pandemic

2021 ◽  
Vol 26 (8) ◽  
pp. 4607
Author(s):  
A. S. Polyakov ◽  
V. V. Tyrenko ◽  
E. V. Kryukov ◽  
Ya. A. Noskov
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Anticoagulant Therapy ◽  
Organ Damage ◽  
Optimal Choice ◽  
Common Type ◽  
Thromboembolic Events ◽  
Nonvalvular Atrial Fibrillation ◽  
Initial Infection ◽  
Supraventricular Tachyarrhythmia

Already at the very beginning of COVID-19 pandemic, it became known about the key clinical and pathogenetic significance of immunopathological reactions and disorders of hemostasis. Specific coagulopathy, microvascular thromboinflammatory organ damage, macrothrombosis and thromboembolism in the acute period of COVID-19, as well as secondary hemostasis disorders in convalescents, actualize the issues of caring patients with cardiovascular disease. COVID-19 not only increases the risk of thromboembolic events for patients with previously identified arrhythmias, but can also indirectly cause it (as a complication of infection or therapy). The aim of this work was to summarize the data and substantiate the optimal choice of prophylactic anticoagulant therapy for nonvalvular atrial fibrillation during the COVID-19 pandemic. Atrial fibrillation is not only the most common type of supraventricular tachyarrhythmia, but it is also the main underlying cause of more than half of cardioembolic stroke cases, which requires effective thromboprophylaxis. While maintaining the infectious danger for patients, the anticoagulant selection should take into account the possible dysfunctions and drug interactions during the initial infection or reinfection of COVID-19, as well as the possibility of rapid anticoagulant action reverse if surgery is required or bleeding develops. The optimal choice seems to be the use of dabigatran, which is characterized by the best safety profile for hepato- and nephrotoxicity, cytochrome P450-independent metabolism, and the presence of an antidote.

Influences of Intravenous Thrombolysis with Recombinant Tissue-type Plasminogen Activator on the Outcome of Atrial Fibrillation Patients with Acute Ischemic Stroke: A Case a Case-control Study of 227 Patients

2021 ◽  
Author(s):  
Hai-xia Wang ◽  
Nan Zhang ◽  
Guo-Qiang Wang ◽  
Yong-hua Huang
Keyword(s):  
Atrial Fibrillation ◽  
Tissue Type ◽  
Short Term ◽  
Nihss Score ◽  
Tissue Type Plasminogen Activator ◽  
Poor Outcome ◽  
Type Plasminogen Activator ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Background: It is a debatable topic about the benefit of intravenous (IV) thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) for atrial fibrillation (AF) patients with acute ischemic stroke (AIS). This study aimed to identify whether IV rt-PA could improve the short-term outcome of patients with AF-AIS.Methods: Medical data of patients with AIS onset within 72hs admitted in the department of neurologic of our hospital between January 1st, 2015 and December 31, 2020 were extracted. The AF-AIS patients were selected and divided into IV rt-PA group (group A) and non-rt-PA group (group B). The baseline characteristics, imaging changes and modified Rankin Scale (mRS) score (≤ 2 as good prognosis, > 2 as poor, = 6 as death) at discharge were obtained to compare the differences between the two groups. Logistic regression was used to analyze the factors influencing on the outcome. Results: Among a total of 1663 AIS patients, there were 280 had AF, of them 227 AF-AIS cases were conformed to the inclusion criteria, including 45 in group A and 182 in group B. All of AF-AIS patients, 48.0% had larger size of infarction and 62.1% had National Institute of Health stroke scale (NIHSS)score more than 10, the differences in the size and NIHSS between the two groups were not significant. A total of 51 cases (22.5%) died during hospitalization, the difference between group A and group B was not obvious (20.0% vs. 23.1%, P=0.658). The cumulative poor outcome (including deaths) at discharge was 75.3%, the difference between the two groups was also not significant (77.8% vs. 74.7%, P=0.671). The incidence of hemorrhagic transformation (HT) in group A was higher than that of in group B (40.0% vs. 21.4, P=0.010), the same was true for parenchymal hematoma (PH) in group A than group B (22.2% vs. 5.5%, P = 0.001). On univariate analysis, poor outcome was significantly associated with infarct size, NIHSS and PH, but not thrombolysis. The proportion of PH in patients with poor outcome between the two groups was also not remarkable. On adjusted multiple logistic regression analysis, both baseline infarction size [(P=0.013, odds ratio (OR) =4.558, 95% 95% confidence interval (CI): 1.373- 15.133] and NIHSS (P<0.001, OR=1.348, 95% CI=1.219-1.491) but not thrombolysis or PH entered into the final model as significant independent risk factors of poor outcome. Conclusion: Patients with AF-AIS had larger infarction size, higher NIHSS score, higher rate of mortality and worse outcome, for them, the IV rt-PA increased the incidence of PH except significantly improved their short-term prognosis.

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