Evolution of Plasma D-Dimer and Fibrinogen in Witnessed Onset of Paroxysmal Atrial Fibrillation

Abstract

Background: Although increased D-dimer and fibrinogen have been proved to be related with atrial fibrillation (AF), their evolution in the course of time remains unclear. Methods: To elucidate the evolution of plasma D-dimer and fibrinogen in AF of different duration. 56 patients (group A) of 3,524 patients in whom the onset of AF had been witnessed in a chest pain clinic were enrolled for study. Plasma D-dimer and fibrinogen concentrations were checked within 30 min after the onset of AF and followed up as scheduled. Another 50 patients (group B) with chronic AF underwent the same protocol and served as controls. Results: In group A, the D-dimer levels reached a plateau at the 18th hour (382 ± 52 vs. 840 ± 280 ng/ml, p < 0.001 by ANOVA) and the fibrinogen level increased gradually from 4.1 ± 0.6 g/ml at baseline to 6.1 ± 0.9 g/ml at the 48th hour (p < 0.001). No subjects had evidence of intra-cardiac thrombi by transesophageal echocardiography. There were significant differences in plasma D-dimer and fibrinogen levels between the two groups at each measurement. At the cut- off value of 500 ng/ml, plasma D-dimer had a sensitivity of 100%, a specificity of 93% in defining AF lasting for less than 12 h. The positive and negative predictive values were 52% and 100%, respectively. Plasma D-dimer increased above the normal range prior to the 12th hour after the onset of AF. Conclusion: The observations support its use as a screening tool for identifying patients with short duration AF capable of being safely converted.

Oral direct thrombin inhibitor AZD0837 for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation: a randomized dose-guiding, safety, and tolerability study of four doses of AZD0837 vs. vitamin K antagonists

“…Although the biomarker has limitations, increased d -dimer levels have been detected in patients when changing from sinus rhythm to paroxysmal AF. 19 Additionally, even though high levels of fibrin d -dimer are not necessarily caused by fibrin formation in a thrombus in the atrium of the heart, low levels could be helpful in excluding the presence of left atrial appendage thrombi. 20 Measurement of d -dimer levels has shown large variability, which was also observed in the present study.…”

Evaluating the Atrial Myopathy Underlying Atrial Fibrillation

“…156 In those with new onset AF, D-dimer levels increase above the normal range within 12 hours, and reach a plateau at the 18 th hour. 157 In patients with chronic AF, the range of D-dimer increase is characteristic for each patient and is stable over time. 158 In patients with chronic AF, elevated levels of platelet factor-4 are observed.…”

Short-term rapid atrial pacing alters the gene expression profile of rat liver: Cardiohepatic interaction in atrial fibrillation

“…11,12 Notably, serum fibrinogen and D-dimer levels are elevated in patients just after 12 h following the AF onset. 13,14 However, the mechanism underlying enhanced blood coagulability associated with AF has not been fully elucidated till date.…”