Coagulation activity is increased in the left atrium of patients with mitral stenosis

Yamamoto, Keiji; Ikeda, Uichi; Seino, Yoshitane; Mito, Hideaki; Fujikawa, Hideyuki; Sekiguchi, Hiromichi; Shimada, Kazuyuki

doi:10.1016/0735-1097(94)00322-h

Cited by 98 publications

(51 citation statements)

References 44 publications

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“…243 In patients with rheumatic mitral stenosis undergoing trans-septal catheterization for balloon valvuloplasty, levels of fibrinopeptide A, thrombin-antithrombin III complex, and prothrombin fragment F1.2 are increased in the LA compared with the RA and femoral vein, indicating regional activation of the coagulation system. 244,245 Whether such elevations are related to AF, for example, through atrial pressure overload or due to another mechanism has not been determined. Regional coagulopathy is associated with SEC in the LA and hence with atrial stasis.…”

Section: Pathophysiology Of Thrombus Formationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,882

589

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Section: Pathophysiology Of Thrombus Formationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,882

589

View full text Add to dashboard Cite

“…Thirdly, blood samples were not obtained from peripheral veins; however, a previous study clearly demonstrated no difference in coagulation activity between peripheral veins and the SC. 31 Fourthly, some selection biases may be present between the discontinuous and continuous warfarin groups. A randomized trial is necessary to increase the accuracy of the present results.…”

Section: Study Limitationsmentioning

confidence: 99%

Predictors of Left Atrial Coagulation Activity Among Paroxysmal Atrial Fibrillation Patients

Yashiro

Arimoto

Hashimoto

et al. 2014

Circ J

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Background:The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear. Methods and Results:We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59±0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194−4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025). Conclusions

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“…The size of the LAA 9,10,11,12 and the presence of spontaneous echo contrast 13,14,15,16,17 are considered positive predictors of LA thrombus. Mitral valve area (MVA) is inversely related to the presence of spontaneous echo contrast (SEC) 6,18,19,20,21,22 . Atrial fibrillation (AF) which occurs in more than 40% of patients with MS later in the course of the disease carries a 17-fold increased risk of thromboembolism 23,24 .…”

Section: Introductionmentioning

confidence: 99%

“…Emboli can be recurrent and multiple in up to a quarter of patients 3 . A pro-thrombotic state exists in the left atrium (LA) in patients with MS even with appropriate anticoagulation therapy 5,6 . The left atrial appendage (LAA) is the commonest site of thrombus formation 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Thromboembolic events in Sudanese patients with rheumatic mitral stenosis

Suliman¹

2017

SHJ

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Abstract:Background Rheumatic mitral stenosis (MS) is a common problem in the Sudanese community, usually affecting the younger population. It can be a crippling condition with many complications, thromboembolism being one of the most serious. Objective The aim of this study is to quantify the prevalence of thromboembolism and to identify its risk factors in Sudanese patients with MS at Ahmed Gasim Cardiac Centre. Methodology Records of patients admitted from Jan 1999-Jan 2003, were retrospectively reviewed and data from various clinical and echocardiographic variables were recorded. Results A total of 412 patients were studied, 142 (34.5%) were males, 270 (65.5%) were females. There were no significant differences in the gender (P = 0.606) or severity of symptoms between patients with and without thromboembolism. Patients with thromboembolism were older (P < 0.016), had more frequent atrial fibrillation (P = 0.017), smaller mitral valve area (P = 0.021) and higher pulmonary artery pressure (P = 0.012) compared to patients without thromboembolism. Dilated left atrial (LA) size was significantly associated with thromboembolism (P = 0.034), spontaneous echo contrast (P = 0.048) and the presence of LA or left atrial appendage (LAA) thrombus (P = 0.029). The presence of LA/LAA thrombus was significantly associated with both thromboembolism (P = 0.05) and spontaneous echo contrast (P < 0.0001). Transoesophageal echocardiography was more sensitive in detecting both spontaneous echo contrast (P < 0.0001) and LA/LAA thrombus (P < 0.0001) than transthoracic echocardiography. Conclusion These results highlight the clinical and echocardiographic risk factors for thromboembolism, the sensitivity of transoesophageal echo for assessment of those patients, and the need for early referral for percutaneous transvenous mitral commisurotomy (PTMC)

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Coagulation activity is increased in the left atrium of patients with mitral stenosis

Abstract: The coagulation system is activated in the left atrium of patients with mitral stenosis even during anticoagulation.

Cited by 98 publications

References 44 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Predictors of Left Atrial Coagulation Activity Among Paroxysmal Atrial Fibrillation Patients

Thromboembolic events in Sudanese patients with rheumatic mitral stenosis

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