Topaloglu Serkan, Boyaci Ayca, Ayaz Selime, Yilmaz Sevinç, Yanik Oya, Ozdemir Ozcan, Soylu Mustafa, Demir Ahmet Duran, Aras Dursun, Kisacik Halil Lutfi, Korkmaz Sule
Department of Cardiology, Ankara Turkiye Yuksek Ihtisas Hospital, 06100 Sihhiye, Ankara, Turkey.
Angiology. 2007 Feb-Mar;58(1):85-91. doi: 10.1177/0003319706297917.
Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p < 0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p < 0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p < 0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p < 0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.
抗凝治疗可预防二尖瓣狭窄（MS）合并心房颤动（AF）患者发生系统性栓塞，但对于窦性心律患者，这种治疗存在争议。作者旨在确定MS合并窦性心律患者的止血变化。本研究纳入了46例二尖瓣狭窄患者（28例为窦性心律，18例为房颤）。他们研究了这些患者的体循环静脉纤维蛋白原、D-二聚体、抗凝血酶III、组织型纤溶酶原激活剂（tPA）、纤溶酶原激活剂抑制剂-I（PAI-I）、血管性血友病因子（vWF）和血小板因子4（PF 4）。患者首先根据心律分为窦性和房颤组，然后根据左心房自发显影对比（LASEC）的存在情况进行分类。与对照组相比，MS合并窦性心律或房颤患者的纤维蛋白原、D-二聚体、抗凝血酶III、vWF和PF 4水平显著升高（p<0.05）。无论心律是窦性还是房颤，LASEC患者的纤维蛋白原、D-二聚体、抗凝血酶III、vWF和PF 4水平均显著高于对照组（p<0.05）。仅PF 4在房颤组中高于窦性心律组（p<0.05）。至于纤溶酶原激活剂和PAI-I水平，仅发现房颤组的组织型纤溶酶原激活剂水平高于窦性心律组和对照组（p<0.05）。在二尖瓣狭窄合并窦性心律的患者中，如果存在LASEC，其凝血激活、血小板激活和内皮功能障碍与房颤患者相似，这些患者应考虑抗凝治疗。
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