Anticoagulant therapy modifies fibrinolytic dysfunction in chronic atrial fibrillation

Objective: We evaluated the changes in fibrinolytic activation markers befo re starting anticoagulation, at 1 and 6 months following the introduction o f anticoagulant therapy. Design and Methods: Tissue plasminogen activator ( t-PA), its endothelial inhibitor (PAI-1), plasmin:antiplasmin complexes (PA Pc), modified antithrombin III (ATM), D dimer (D-D) and fibrinogen (FIB) we re measured in 36 patients with chronic atrial fibrillation. Fifteen of the m had rheumatic mitral stenosis and 21 had nonrheumatic atrial fibrillation . Basal levels were compared with a sex- and age-matched healthy control gr oup. Results: At baseline, patients with atrial fibrillation showed signifi cantly higher plasma levels of PAI-1,ATM, D-D and FIB levels (p < 0.05) tha n controls, and no differences in t-PA and PAPc concentrations. Levels of t -PA, PAI-1, ATM and D-D decreased significantly under anticoagulant therapy , whereas FIB levels were not significantly modified. PAPc levels were sign ificantly increased at 6 months in the rheumatic group but did not differ s ignificantly in the nonrheumatic group. Conclusions: Patients with chronic atrial fibrillation show a hypercoagulant state and a relatively low fibrin olytic function. After 6 months of anticoagulant therapy, an improvement in fibrinolytic function markers was detected. Copyright (C) 2001 S. Karger A G, Basel.