Determinants of Increased Regional Left Atrial Coagulation Activity in Patients With Mitral Stenosis

Peverill, Roger E.; Rw, Harper; Gelman, John S.; Te, Gan; Harris, Geoffrey M.; Jj, Smolich

doi:10.1161/01.cir.94.3.331

Cited by 79 publications

(87 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Not many investigators have focused on blood coagulation in patients with MS and SR. Elevated peripheral venous levels of DD, ATIII, and fibrinogen have been reported, 5,12,13) however, Peverill, et al 11) claimed that coagulation was increased mainly in the left atrium of patients with MS in SR. Our results indicated increased intravascular fibrin turnover in peripheral venous and left atrial blood samples of patients with MS, expressed by the increased levels of DD and ATIII. Moreover, significantly lower FVII, but normal FVIII levels, in the left atrium of patients with AF suggest activation in the extrinsic pathway and increased consumption.…”

Section: Discussionmentioning

confidence: 99%

Regional Left Atrial Coagulation and Fibrinolytic Activities in Patients With Mitral Stenosis

et al. 2004

View full text Add to dashboard Cite

SUMMARYSystemic thromboembolism is a major complication of mitral stenosis (MS), especially in those patients having atrial fibrillation (AF). Recent evidence has suggested that regional left atrial coagulation activity may be increased in MS and may contribute to the pathophysiology of left atrial thrombus. However, the relation of left atrial coagulation activity to factors that predispose to left atrial thrombus formation is unknown. Also, the relations between left atrial and systemic coagulation activity, fibrinolysis, and platelet activation remain unresolved.Left atrial and peripheral venous levels of fibrinogen, antithrombin III, factor VII and factor VIII for coagulation, D-dimer, tPA and PAI-I, plasmin and antiplasmin for fibrinolysis, and platelet factor 4 and vWF for platelet activation, and endothelial dysfunction were measured in 46 patients with MS and normal clotting times who were undergoing percutaneous mitral valvuloplasty.Left atrial tPA, plasmin, PAI-I, antiplasmin, PF4, and vWF levels exceeded the corresponding peripheral venous levels (P < 0.05) in patients with MS, being more significant in the AF subgroup. There were no significant differences between left atrial and peripheral venous levels of fibrinogen, D-dimer, factor VII, and factor VIII within the patient group (P > 0.05).The results suggest that there are significant variations in the indices of coagulation, fibrinolytic system and platelet activation, and endothelial dysfunction between left atrial and peripheral venous blood samples of patients with MS that may be due to limited spillover from the left atrium to the systemic circulation. (Jpn Heart J 2004; 45: 779-788)

show abstract

Section: Discussionmentioning

confidence: 99%

Regional Left Atrial Coagulation and Fibrinolytic Activities in Patients With Mitral Stenosis

et al. 2004

View full text Add to dashboard Cite

show abstract

“…Although a number of review articles, [25][26][27][28][29][30][31][32][33][34] meta-analyses, 35,36 and decision analyses 37,38 have evaluated the use of warfarin and aspirin, few 30,39 have objectively graded the strength of the evidence that supports use of these medications.…”

Section: Discussionmentioning

confidence: 99%

“…All of the studies excluded patients with rheumatic valvular disease, for whom there is strong evidence that anticoagulation is indicated. 26 Importantly, the EAFT trial 19 and the indobufen study 24 were secondary prevention trials (i.e., they enrolled patients who had already had a stroke or transient ischemic attack). Thus, the results of these studies were interpreted separately from the other trials.…”

Section: Literature Yieldmentioning

confidence: 99%

“…24 Patients on low molecular weight heparin had an OR for stroke of 0.34 (95% CI 0, 1.62) compared with those on placebo. 26 The absolute rates were unclear as the follow-up time was not explicitly stated. The relative risk reduction with this drug appeared to be similar to the risk reduction with warfarin, although the evidence only suggested a benefit.…”

Section: Warfarin Versus Indobufen and Low Molecular Weight Heparin Vmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of thromboembolism in atrial fibrillation

et al. 2000

View full text Add to dashboard Cite

OBJECTIVE: Appropriate use of drugs to prevent thromboembolism in patients with atrial fibrillation (AF) involves comparing the patient's risk of stroke and risk of hemorrhage. This review summarizes the evidence regarding the efficacy of these medications. METHODS:We conducted a meta-analysis of randomized controlled trials of drugs used to prevent thromboembolism in adults with nonpostoperative AF. Articles were identified through the Cochrane Collaboration's CENTRAL database and MEDLINE until May 1998. A trial fibrillation (AF) is an increasingly common cardiac dysrhythmia affecting over 2 million people in the United States. 1-3 Restoration of sinus rhythm may involve consultation with a cardiologist; however, the prevention of cardioembolic events in patients who remain in AF falls within the domain of the primary care physician. 4 With a recently estimated 3.9 million office visits yearly for patients with AF, 5 internists need to aware of the current evidence regarding prevention of thromboembolic disease in order to provide the best care for their patients. MAIN RESULTS:The estimate that only one third of patients in AF are receiving warfarin is remarkably consistent across studies, 4,6-8 and has raised concerns that warfarin is greatly underutilized in patients with chronic AF. However, for interventions like warfarin that involve significant trade-offs, clinicians need a reliable synthesis of information on risks and benefits in order to make appropriate recommendations to patients. Therefore, we reviewed all of the randomized controlled trials involving anticoagulants and antiplatelet agents in the prevention of thromboembolism in patients with AF. Our aim was to evaluate the strength of the evidence on the efficacy and safety of the drugs used for the prevention of thromboembolic complications in adults with nonpostoperative AF and to report this information in a format useful to clinicians.

show abstract

“…In addition to Virchow's triad, localized blood stagnation is associated with localized activation of coagulability. 21 Nevertheless, patients with AF and LAA thrombus may require more intensive anticoagulation, and a large-scale prospective study is needed to address this issue.…”

Section: Pathophysiological Basis For Thromboembolismmentioning

confidence: 99%

Role of Transesophageal Echocardiography in the Prediction of Thromboembolism in Patients With Chronic Nonvalvular Atrial Fibrillation.

et al. 2001

View full text Add to dashboard Cite

Determinants of Increased Regional Left Atrial Coagulation Activity in Patients With Mitral Stenosis

Abstract: Increased regional left atrial coagulation activity in mitral stenosis occurs in the presence of LASEC, is evident in either sinus rhythm or atrial fibrillation, and is associated with normal systemic coagulation activity.

Cited by 79 publications

References 52 publications

Regional Left Atrial Coagulation and Fibrinolytic Activities in Patients With Mitral Stenosis

Regional Left Atrial Coagulation and Fibrinolytic Activities in Patients With Mitral Stenosis

Prevention of thromboembolism in atrial fibrillation

Role of Transesophageal Echocardiography in the Prediction of Thromboembolism in Patients With Chronic Nonvalvular Atrial Fibrillation.

Contact Info

Product

Resources

About