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Regional left atrial coagulation and fibrinolytic activities in patients with mitral stenosis

Ayca Boyaci1, Serkan Topaloglu, Sevinc Yilmaz

  • 1Departments of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.

Japanese Heart Journal
|November 24, 2004
PubMed

Insights

In mitral stenosis (MS) patients, left atrial coagulation and fibrinolysis differ significantly from systemic circulation, particularly in those with atrial fibrillation (AF). These localized changes may explain thrombus formation risks.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Systemic thromboembolism is a serious complication of mitral stenosis (MS), particularly in patients with atrial fibrillation (AF).
  • Increased left atrial coagulation activity is suspected in MS, potentially contributing to thrombus formation.
  • The relationship between left atrial coagulation, fibrinolysis, platelet activation, and systemic markers in MS remains unclear.

Purpose of the Study:

  • To investigate the differences in left atrial versus systemic coagulation, fibrinolysis, and platelet activation markers in patients with MS.
  • To explore the association of these markers with thrombus formation risk factors.

Main Methods:

  • Measurement of coagulation (fibrinogen, factors VII, VIII), fibrinolysis (D-dimer, tPA, PAI-I, plasmin, antiplasmin), platelet activation (PF4, vWF), and endothelial dysfunction markers.
  • Comparison of left atrial and peripheral venous blood levels in 46 MS patients undergoing percutaneous mitral valvuloplasty.
  • Subgroup analysis for patients with atrial fibrillation (AF).

Main Results:

  • Left atrial levels of tPA, plasmin, PAI-I, antiplasmin, PF4, and vWF were significantly higher than peripheral venous levels (P < 0.05).
  • These differences were more pronounced in the AF subgroup.
  • No significant differences were observed in fibrinogen, D-dimer, factor VII, or factor VIII levels between left atrial and peripheral venous blood.

Conclusions:

  • Significant regional variations exist in coagulation, fibrinolysis, and platelet activation markers within the left atrium compared to systemic circulation in MS patients.
  • These localized prothrombotic changes in the left atrium may be due to limited systemic spillover.
  • Findings highlight potential mechanisms for thrombus formation in MS, especially in AF patients.

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