Paroxysmal atrial fibrillation: changes in factor VIII and von Willebrand factor impose early hypercoagulability

Abstract

Introduction Paroxysmal atrial fibrillation (PAF) is a well-documented prothrombotic state that carries significant embolic risk. However, precise hemostatic changes in the very early stage of the disease are not completely studied. The aim of the study was to study von Willebrand factor (vWF) and coagulation factor VIII (FVIII) plasma levels and activity in the first hours (up to 24 h) of PAF clinical manifestation. Material and methods We selected consecutively 51 non-anticoagulated patients (26 men, 25 women, mean age: 59.84 ±1.60) with PAF and 52 controls (26 men, 26 women, mean age: 59.50 ±1.46 years) corresponding in gender, accompanying diseases and conducted treatment. The indicators were examined using enzyme-linked immunoassays and photometric tests. Results All patients were hospitalized between the 2 nd and 24 th h after the onset of arrhythmia (mean: 8.14 ±0.74 h). Higher FVIII levels (107.52 ±3.48% vs. 93.85 ±2.93%, p < 0.05) and activity (200.03 ±11.11% vs. 109.73 ±4.90%, p < 0.001) were found in the PAF group. vWF levels (178.40 ±12.95% vs. 119.53 ±6.12%, p < 0.001) and activity (200.92 ±12.45% vs. 110.80 ±5.14%, p < 0.001) were also higher. These changes did not depend on age, sex, body mass index or CHA 2 DS 2 -VASc score in the PAF group ( p > 0.05). PAF duration was a significant predictor of increased FVIII levels and activity. Increased PAF duration was followed by increased values of the factors ( r = 0.85, p < 0.001; r = 0.83, p < 0.001). Conclusions The results presented an activated coagulation cascade and endothelial injury, suggesting hypercoagulability still in the early hours of PAF. These changes in PAF did not correlate with CHA 2 DS 2 -VASc score risk factors, outlining PAF as a possible independent embolic risk factor.

Prevalence and determinants of atrial fibrillation progression in paroxysmal atrial fibrillation

“…The origin of both and the role in AF progression remains unknown, but the postulated enhanced potential of tissue factor stimulated coagulation, due to lower TFPI activity, by itself would be in accordance with a role of hypercoagulability in driving AF as previously shown in preclinical studies 9. Recently, it was shown that duration of PAF was associated with higher levels of von Willebrand factor and factor VIII 26. Clearly, more research is warranted on the role of hypercoagulability in AF progression.…”

The association of coagulation and atrial fibrillation: a systematic review and meta-analysis

“…Fourteen studies examined platelet count in AF and controls (868 AF patients, 2269 controls, mean age 62.6 years, 39.5% women). 50,52,56,64,68,69,71,74,[76][77][78][79][80][81] The mean platelet count in AF patients was 235 × 10 9 /l (range 174-277 × 10 9 /l), and 225 × 10 9 in controls (range 212-270 × 10 9 ). Pooled, we found no significant difference between the two groups (SMD −0.41, 95% CI −1.42 to 0.59).…”

Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects

“…In humans, AF is associated with a reduced quality of life and increased morbidity and mortality due to several factors, including atrioventricular dyssynchrony, progressive cardiac dysfunctions and altered hemodynamics [20,107]. Unlike horses, humans with pAF are at increased risk of stroke due to reduced atrial systole and increased atrial stasis [108], while pAF also initiates an early state of hypercoagulability [109]. A study investigating hypercoagulability in horses with AF could not support findings from human studies [110].…”