Atrial Fibrillation and the Prothrombotic State in the Elderly

Abstract

Background and Purpose-Atrial fibrillation (AF) is a major cause of stroke among the elderly. Evidence for a prothrombotic state in AF is controversial, and there is a lack of studies among the elderly. We studied the relationships between AF and 3 prothrombotic plasma markers-von Willebrand factor (vWf; a marker of endothelial damage/ dysfunction), soluble P-selectin (sP-sel; a marker of platelet activation), and fibrinogen-in a matched case-control study nested within a large community-based study of an elderly population. Methods-We identified 162 elderly participants (meanϮSD age, 78Ϯ8 years; 51% male) in the Rotterdam Study with documented AF and matched each case by age and sex to 2 population controls. vWf and sP-sel were measured by enzyme-linked immunosorbent assay; fibrinogen was measured with the Clauss method. We used conditional logistic regression analysis to assess the relationships between the markers and AF, adjusting for potential confounders. Results-There were no significant relationships between either fibrinogen (Pϭ0.8) or sP-sel (Pϭ0.6) and AF. However, a positive linear relationship between vWf level and presence of AF remained significant after adjustment for potential confounders among women (odds ratio [OR], 1.17; 95% CI, 1.02 to 1.34) per 10-IU/dL increase in vWf but not among men (OR, 1.06; 95% CI, 0.96 to 1.17). Conclusions-We observed a positive relationship between AF and plasma vWf (or endothelial damage/dysfunction) in our elderly population, which was most apparent among women. Fibrinogen and sP-sel levels were unrelated to AF. The prothrombotic state of AF may be subject to sex differences, but longitudinal studies are needed to determine the relationship between these plasma markers and stroke risk.

Impact of Atrial Fibrillation on Outcome in Thrombolyzed Patients With Stroke

“…This is in line with prior studies showing that age has an independent and additive effect on the hypercoagulable or prothrombotic state in AF. 25,26 …”

Prognostic Value of Plasma von Willebrand Factor and Soluble P-Selectin as Indices of Endothelial Damage and Platelet Activation in 994 Patients With Nonvalvular Atrial Fibrillation

“…9 -11 However, this study is the first to demonstrate that raised levels of one such marker (vWf) can predict clinical outcome (including stroke) in AF, although uncertainty remains as to whether it is AF itself or simply the presence of additional underlying cardiovascular conditions that determines elevation of these markers in AF. 13,22,23 Because of the exclusion of patients assigned adjusteddose warfarin, our cohort featured predominantly low-to moderate-risk patients (thus, the number of incident strokes were relatively few), and all were treated with aspirin, factors that must be considered before applying our study findings to all populations with AF. Nonetheless, it is notable that although plasma levels of vWf (an index of endothelial damage/dysfunction) predicted stroke and the composite end point of stroke, MI, or vascular death among our whole cohort of 994 AF patients, plasma levels of sP-sel (an index of platelet activation) did not, and in a previous substudy from the SPAF III trial, 4 other prothrombotic markers (fibrinogen, ␤-thromboglobulin, prothrombin fragment F1.2, and factor V Leiden) also failed to predict outcome.…”

Atrial Fibrillation and the Risk of Ischemic Stroke

“…In a study performed by Conway et al 18 that enrolled 162 AF patients and 324 controls, a higher von Willebrand factor level was noted among females with AF, but not among males with AF, when compared with that of non-AF patients. Wang et al 19 further demonstrated that females with AF had a higher level of tissue plasminogen activator antigen after adjusting for other clinical factors, including body mass index, blood pressure, and lipid profiles.…”