Indexes of hypercoagulability measured in peripheral blood reflect levels in intracardiac blood in patients with atrial fibrillation secondary to mitral stenosis

Systemic thromboembolism is a major complication in patients with mitral st enosis, especially in those who have atrial fibrillation (AF). It has been suggested that there may be increased regional left atrial coagulation acti vity in such patients, despite normal systemic coagulation activity on peri pheral blood sampling. Our aim was to investigate whether there were signif icant differences between intracardiac versus peripheral indexes of hyperco agulability in 25 patients (5 men; mean age 60 years) with mitral stenosis who were undergoing percutaneous balloon mitral valvuloplasty and who were all in chronic AF. Two days after halting warfarin therapy, intracardiac (r ight and left atria) and peripheral (venous and arterial) blood samples fro m patients were obtained and compared with levels in matched healthy contro ls in sinus rhythm, Thrombogenicity was assessed by levels of fibrin D-dime r, fibrinogen, indexes of platelet activation (soluble P-selectin and beta thromboglobulin [beta TG]) and indexes of endothelial dysfunction (soluble thrombomodulin [sTM] and van Willebrand factor [vWF]). There were no statis tically significant differences in the various markers between the femoral vein and artery, left and right atria, and between the femoral vein and bot h atria (all p = NS). Plasma fibrinogen, vWF (both p <0.005), and D-dimer ( p = 0.011) were significantly higher and levels of sP-selectin and sTM were lower (both p <0.005) in patients when compared with controls, There was n o significant difference in plasma beta TG levels, Our results suggest that there is no significant variation in indexes of thrombogenesis, platelet a ctivation, and endothelial dysfunction between left atrium, right atrium, a nd the peripheral artery or vein. Peripheral samples therefore do reflect a trial coagulation, platelet, and endothelial activities. (C)1999 by Excerpt a Medico, Inc.