DETECTION OF A HYPERCOAGULABLE STATE IN NONVALVULAR ATRIAL-FIBRILLATION AND THE EFFECT OF ANTICOAGULANT-THERAPY

The purpose of the study was to evaluate alterations of the hemostatic system and the effect of anticoagulant therapy in nonvalvular atrial fibrillation. A set of molecular hematologic markers was measured pros pectively in 69 patients with atrial fibrillation and 28 age-matched p atients in sinus rhythm. Significantly elevated levels of thrombin-ant ithrombin III complex (8.5 +/- 1.6 vs. 2.5 +/- 0.3 mu g/l; p < 0.001), fibrin monomers (27.1 +/- 3.2 vs. 13.4 +/- 3.7 nM; p < 0.001), D-dime rs (788 a 76 vs. 405 +/- 46 mu g/l; p < 0.005), and tissue-type plasmi nogen activator (9.6 +/- 0.5 vs. 7.2 +/- 0.5 mu g/l; p < 0.05) were ob served in patients with atrial fibrillation compared to those in sinus rhythm. In a subgroup of patients in whom anticoagulant therapy with oral coumadin or standard intravenous heparin was established after th e initial study, hemostatic activation decreased significantly. In con clusion, molecular hematologic markers indicate a hypercoagulable stat e in atrial fibrillation which may characterize a group of patients at elevated risk for thromboembolic disease.