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Nonvalvular atrial fibrillation: evidence for a prothrombotic state
S R Kahn1, S Solymoss, K M Flegel
1Division of General Internal Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Que. susank@epid.jgh.mcgill.ca
Summary
Patients with nonvalvular atrial fibrillation (NVAF) exhibit prothrombotic changes. Those without a prior embolic event show higher hemoglobin and fibrinogen, while those with a prior event mirror stroke patients, indicating a prothrombotic state.
Area of Science:
- Cardiology
- Hematology
- Thrombosis Research
Background:
- Nonvalvular atrial fibrillation (NVAF) is associated with an increased risk of thromboembolic events.
- Understanding the prothrombotic state in NVAF patients is crucial for risk stratification and management.
Purpose of the Study:
- To investigate prothrombotic changes in patients with NVAF compared to individuals in sinus rhythm.
- To differentiate prothrombotic markers based on the presence or absence of a prior embolic event in NVAF patients.
Main Methods:
- A cross-sectional study comparing hemostatic function in NVAF patients and control subjects.
- Patients were stratified into groups with and without prior thrombotic/embolic events.
- Assessed various hemostatic markers including platelet count, coagulation times, and specific protein levels.
Main Results:
- NVAF patients without prior embolic events showed elevated hemoglobin and fibrinogen levels.
- NVAF patients not on warfarin exhibited lower protein C and S levels and higher fibrinopeptide A.
- NVAF patients with prior embolic events displayed similar hemostatic alterations as control subjects with prior thrombotic stroke.
Conclusions:
- NVAF patients without prior embolic events demonstrate a prothrombotic state compared to controls without thrombotic stroke.
- NVAF patients with a history of embolic events show a prothrombotic state comparable to controls with prior thrombotic stroke.
- Further prospective studies are warranted to assess the predictive value of these abnormalities for stroke risk in individual NVAF patients.