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Increased systemic coagulation activity in patients with rheumatic mitral stenosis: assessment of the clinical and
Y Büyükaşik1, M Ileri, O I Ozcebe
1Department of Hematology, Hacettepe University Medical School, Ankara, Turkey. yahyab@neuron.ato.org.tr
Insights
Patients with rheumatic mitral stenosis show increased systemic coagulation activity. Severe mitral regurgitation and left atrial spontaneous echo contrast are key factors contributing to this prethrombotic state.
Area of Science:
- Cardiology
- Hematology
- Rheumatology
Background:
- Rheumatic mitral stenosis is a significant valvular heart disease.
- A prethrombotic state may increase the risk of thromboembolic events in these patients.
Purpose of the Study:
- To investigate systemic coagulation activity in rheumatic mitral stenosis.
- To identify predictors of a hypercoagulable state in this patient population.
Main Methods:
- Measured thrombin-antithrombin III complex levels in 84 patients with rheumatic mitral stenosis.
- Utilized transesophageal echocardiography to exclude left atrial thrombus.
- Employed multivariate logistic regression analysis to identify significant predictors.
Main Results:
- Patients with rheumatic mitral stenosis exhibited significantly elevated thrombin-antithrombin III complex levels compared to healthy controls (P<0.001).
- Severe mitral regurgitation (OR=6.7) and left atrial spontaneous echo contrast (OR=22.8) were identified as independent predictors of increased coagulation activity.
Conclusions:
- Systemic coagulation is activated in patients with rheumatic mitral stenosis.
- Severe mitral regurgitation and left atrial spontaneous echo contrast are significant determinants of this increased coagulation activity, indicating a prethrombotic state.
Abstract:
In this study, we aimed to determine systemic coagulation activity in patients with rheumatic mitral stenosis and to define determinants of a possible prethrombotic state. Peripheral venous plasma level of thrombin-antithrombin III complex was measured in 84 consecutive patients with rheumatic mitral stenosis who had no left atrial thrombus by transesophageal echocardiography. The patients had significantly higher thrombin-antithrombin III complex values (mean +/- SD = 9.6+/-15.9 ng/ ml) compared with the healthy subjects (2.1+/-1.8 ng/ml) (P<0.001). Among many clinical and echocardiographic variables, severe mitral regurgitation (odds ratio = 6.7, P<0.001) and left atrial spontaneous echo contrast (odds ratio = 22.8, P<0.001) appeared as significant predictors of the increased systemic coagulation activity in multivariate logistic regression analysis. In conclusion, systemic coagulation activity is increased in the patients with rheumatic mitral stenosis, and coexistence of severe mitral regurgitation and presence of left atrial spontaneous echo contrast are determinants of this increment.