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[Examinations to detect left atrial thrombus and blood coagulation test analyses in aged patients with atrial
M Sakai1, A Hamamatsu, K Kuboki
1Division of Cardiology, Tokyo Metropolitan Geriatric Hospital.
Insights
Patients with atrial fibrillation (Af) and abnormal blood coagulation tests show a higher risk of left atrial (LA) thrombus or aortic plaque. Specific coagulation markers like FDP-E, D-dimer, and PIC indicate increased embolism risk.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Context:
- Atrial fibrillation (Af) is associated with an increased risk of thromboembolism.
- Transesophageal echocardiography (TEE) is used to detect left atrial (LA) thrombus.
- Blood coagulation tests can provide insights into thrombotic risk.
Purpose:
- To investigate the association between left atrial (LA) thrombus and various blood coagulation tests in patients with atrial fibrillation (Af).
- To identify specific coagulation markers indicative of embolism risk in Af patients.
Summary:
- Forty Af patients and 21 controls underwent TEE and blood coagulation tests (TAT, PAI-1, PIC, D-dimer, tPA, FDP-E, etc.).
- Increased FDP-E, D-dimer, and PIC levels were observed in patients with LA thrombi or aortic plaque compared to controls.
- Patients with >4 abnormal coagulation values (Group A) had a significantly higher incidence of LA thrombi or aortic plaque (72%) versus those with <3 abnormalities (Group B, 13%).
- Warfarin therapy resolved LA thrombi in 4/6 patients; however, higher tPA, PAI-1, and tPA.PAI-1 complex levels were noted in non-resolving cases.
Impact:
- This study highlights the utility of specific blood coagulation tests in screening for embolism risk in Af patients.
- Abnormalities in FDP-E, D-dimer, and PIC may serve as indicators for closer monitoring and potential intervention.
- Identifying patients with multiple coagulation abnormalities can help stratify risk for thromboembolic events.
Abstract:
To screen for risk of embolism, we investigated the association between the presence of left atrial (LA) thrombus by transesophageal echocardiography (TEE) and blood coagulation tests, including thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), plasmin-alpha 2-plasmin inhibitor complex (PIC), D-dimer, tissue plasminogen activator (tPA), free tPA, tPA.PAI-1 complex, prothrombin fragment 1+2 and fibrin degradation product E (FDP-E) in 40 patients with atrial fibrillation (Af) (13 males, 27 females, mean age 76 +/- 8 yrs). Blood coagulation tests were performed in 21 control subjects with sinus rhythm (12 males, 9 females, mean age 75 +/- 4 yrs). LA thrombi were detected in the appendage of 8 patients and in the atrium of 6 patients. Severe atherosclerotic plaque with thrombi in the thoracic aorta were detected in 6 patients without LA thrombi. FDP-E, D-dimer and PIC increased significantly in patients with LA thrombi or aortic plaque in comparison with controls with sinus rhythm. In patients with Af, 25 of them (group A) has more than 4 abnormal coagulation values out of 9 tests and 15 of them (group B) had abnormalities in less than 3 tests. LA thrombi or aortic plaque were detected in 18 patients in group A and 2 patients in group B (72% vs 13%, p < 0.01). In 4 of 6 patients with large LA thrombi, the thrombi were resolved after administration of warfarin. Before administration of warfarin, tPA, PA-1 and tPA.PA-1 complex levels were higher in the two patients whose thrombi did not resolve.(ABSTRACT TRUNCATED AT 250 WORDS)