Hypercoagulability in the left atrium: Part II: Coagulation factors

Area of Science:

• Cardiology
• Hematology
• Pathophysiology

Background:

• Intracardiac thrombus formation is linked to hypercoagulable states.
• Conditions like acute cardioembolic stroke and mitral stenosis are associated with intracardiac thrombus.
• Pathophysiology involves complex interactions between coagulation and fibrinolysis.

Purpose of the Study:

• To review the relationship between hypercoagulable states and intracardiac thrombus.
• To explore the role of dehydration in thrombus formation.
• To evaluate the impact of anticoagulant treatment on intracardiac thrombus.

Main Methods:

• Serial echocardiography to monitor thrombus and inferior vena cava diameter.
• Hematocrit and water balance assessment, especially in patients on diuretics.
• Measurement of plasma markers: fibrinopeptide A, fibrinopeptide B beta 15-42, thrombin-antithrombin III complex, and D-dimer.

Main Results:

• Decreased inferior vena cava diameter correlated with increased hematocrit, suggesting dehydration's role.
• A hypercoagulable and secondarily enhanced fibrinolytic state was identified in cardiac chambers.
• Plasma levels of specific markers indicated this prothrombotic and fibrinolytic state.

Conclusions:

• Dehydration appears to be a significant factor in intracardiac thrombus development.
• Anticoagulant therapy effectively reduces intracardiac thrombus by modulating thrombin activity and promoting fibrinolysis.