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[Improvement in fibrinolytic function following anticoagulant treatment in chronic rheumatic atrial fibrillation]

F Marín Ortuño1, V Roldán Schilling, P Marco Vera

  • 1Sección de Cardiología, Hospital General Universitario de Elche, Alicante.

Revista Espanola De Cardiologia
|February 16, 1999
PubMed

Insights

Patients with rheumatic atrial fibrillation have impaired fibrinolysis, indicated by higher PAI-1 levels. Oral anticoagulation therapy improved these fibrinolytic markers over six months, reducing thromboembolic risk.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Rheumatic atrial fibrillation (AF) patients face high systemic embolism risk, necessitating oral anticoagulation.
  • Fibrinolytic function in these patients is not well understood.
  • This study investigates fibrinolytic activation markers in rheumatic AF patients before and during anticoagulation therapy.

Purpose of the Study:

  • To evaluate fibrinolytic activation markers (tPA, PAI-1, PAP, D-dimer) in rheumatic AF patients.
  • To assess changes in these markers after initiating oral anticoagulation.
  • To explore the relationship between fibrinolytic markers and left atrial diameter/mitral area.

Main Methods:

  • Measured tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), plasmin-antiplasmin complexes (PAP), and D-dimer in 13 rheumatic AF patients and 20 healthy controls.
  • Assessed fibrinolytic markers at baseline, 1 month, and 6 months post-anticoagulation initiation.
  • Utilized transthoracic echocardiography to measure left atrial diameter and mitral area.

Main Results:

  • Rheumatic AF patients exhibited elevated PAI-1 and D-dimer levels compared to controls.
  • A correlation was observed between left atrial diameter and baseline t-PA levels.
  • Anticoagulation therapy led to significant reductions in t-PA, PAI-1, and D-dimer, with a concurrent increase in PAP levels.

Conclusions:

  • Rheumatic AF patients present with a hypofibrinolytic state, primarily due to elevated PAI-1.
  • Oral anticoagulation therapy demonstrates a positive impact on fibrinolytic function markers within six months.
  • These findings support the prophylactic role of oral anticoagulants in mitigating thromboembolic risk in rheumatic AF.
Abstract

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