Markers of coagulation and platelet activation during percutaneous mitral valvuloplasty

The effect of percutaneous mitral valvuloplasty (PMV) on markers of coagulation and platelet activation was investigated to assess whether coagulation or platelet activation take place during and after PMV even under conditions of full heparinization. Before PMV, all the hemostatic parameters studied were in the normal range compared with those of a control group. Two hours after PMV the levels of prothrombin fragment F1 and 2 (F1+2) (1.6+/-0.6 nmol/l versus 0.8+/-0.3 nmol/l, P < 0.005), plasma thrombin-antithrombin III (TAT) complexes (5.4+/-3.2 ng/ml versus 2.2+/-0.9 ng/ml) and beta-thromboglobulin (119+/-70 ng/ml versus 42.2+/-41 ng/ml) had increased significantly compared with those measured at basal conditions. Activated partial thromboplastin time was significantly prolonged (152+/-40 s versus 21+/-5 s), reflecting full heparinization. Levels of fibrinogen, F1+2, TAT and beta-thromboglobulin remained increased 72 h after PMV. We conclude that patients with severe, symptomatic mitral stenosis undergoing PMV need a more specific antithrombotic therapy or a more prolonged and perhaps less intensive heparinization.