Hypercoagulability and chronic atrial fibrillation: the role of markers of thrombin generation.
Hypercoagulability and chronic atrial fibrillation: the role of markers of thrombin generation.
复制标题
高凝状态和慢性心房颤动：凝血酶生成标志物的作用。
作者：
M. Soncini;F. Casazza;R. Mattioli;C. Bonfardeci;A. Motta;Claudio Cimminiello
背景
我们研究了充血性心力衰竭患者，其中一半还伴有慢性非瓣膜性房颤(AF)。根据既往中风病史对患者进行分层。
方法
由于房颤患者可能存在高凝状态，采用凝血酶原片段1+2(F1+2)和凝血酶-抗凝血酶III复合体(TAT)分子标志物研究凝血酶的生成。房颤患者仅有TAT和F1+2升高的趋势，而既往有卒中史的患者凝血酶生成标志物水平升高(TAT卒中+18.95+/-5.15 vs TAT卒中-8.34+/-2.41；F1+2卒中+2.22+/-0.29 vs F1+2卒中-1.32+/-0.12)。应用经食道超声心动图对32例房颤患者的左房内自发回声对比(SEC)进行了研究。
结果
TAT在有SEC的受试者(n=11)中显著升高(TAT秒+37.50+/-13.41vs TAT秒-8.7秒+/-2.51vsTAT秒-8.7+/-2.51，p=0.008)。
结论
最后，当我们将患者分为1)既有房颤又有卒中、2)只有房颤、3)只有卒中和4)无卒中的窦性心律时，有房颤和卒中的患者的F1+2水平比没有卒中的患者高(且略高)，这表明在这些受试者中存在真正的凝血激活状态。
BACKGROUND
We have studied 64 patients with congestive heart failure, half of them also with chronic nonvalvular atrial fibrillation (AF). Patients were also stratified according to a history of prior stroke.
METHODS
The generation of thrombin was investigated by means of the molecular markers prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), because AF patients may have a hypercoagulable state. There was only a trend toward higher values of TAT and F1 + 2 for AF patients, while subjects with previous stroke (irrespective of AF) had increased levels of the markers of thrombin generation (TAT stroke+ 18.95 +/- 5.15 vs TAT stroke- 8.34 +/- 2.41; F1 + 2 stroke+ 2.22 +/- 0.29 vs F1 + 2 stroke- 1.32 +/- 0.12). The presence of spontaneous echo contrast (SEC) within left atrium was also investigated in 32 AF patients by transesophageal echocardiography.
RESULTS
TAT were significantly higher in subjects (n = 11) with SEC (TAT sec+ 37.5 +/- 13.41 vs TAT sec- 8.7 +/- 2.51, p = 0.008).
CONCLUSIONS
Finally, when we grouped into 1) those with both AF and stroke, 2) AF alone, 3) stroke alone and 4) sinus rhythm without stroke, levels of F1 + 2 were higher (and marginally higher TAT) in patients with AF and stroke than in those without stroke, revealing that there is a true clotting activation state in these subjects.