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Effect of sinus rhythm restoration on markers of thrombin generation in atrial fibrillation

Anja Wiedswang Horjen1,2, Ingebjørg Seljeflot2,3, Trygve Berge1,2

  • 1Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, N-3004 Drammen, Norway.

Thrombosis Journal
|January 5, 2018
PubMed

Insights

Restoring sinus rhythm in atrial fibrillation (AF) patients did not normalize thrombogenesis markers. Persistent hypercoagulability suggests AF increases clotting risk even with normal heart rhythm.

Area of Science:

  • Cardiology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) is known to induce a hypercoagulable state.
  • The effect of restoring sinus rhythm on thrombogenesis markers is not well understood.
  • The CAPRAF study investigated this in patients undergoing cardioversion for persistent AF.

Purpose of the Study:

  • To assess the impact of sustained sinus rhythm on prothrombotic markers (ETP, F1+2, D-dimer) after cardioversion for AF.
  • To determine if these markers predict rhythm outcome post-cardioversion.
  • To compare marker levels in AF patients to a healthy reference group.

Main Methods:

  • A double-blind, placebo-controlled study randomized 171 AF patients to candesartan or placebo pre- and post-cardioversion.
  • Measurements of endogenous thrombin potential (ETP), prothrombin fragment 1+2 (F1+2), and D-dimer were taken before cardioversion and at study end.
  • A reference group of 49 subjects without AF was included for comparison.

Main Results:

  • Prothrombotic markers remained unchanged in patients maintaining sinus rhythm for 6 months.
  • Discontinuation of warfarin in 13 low-risk patients with sinus rhythm showed significantly higher D-dimer and F1+2 levels compared to controls.
  • No measured marker predicted rhythm outcome after electrical cardioversion.

Conclusions:

  • Sustained sinus rhythm for 6 months post-cardioversion does not normalize ETP, F1+2, or D-dimer levels in AF patients.
  • Elevated D-dimer and F1+2 levels persist in AF patients even with long-term sinus rhythm, suggesting ongoing hypercoagulability.
  • These findings indicate persistent thrombotic risk in AF patients despite successful rhythm control.
Abstract

Keywords:
Atrial fibrillationCardioversionHypercoagulabilityThrombin generation

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