Department of Cardiac Surgery, Anaesthesiology and Experimental Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland; John Paul II Hospital, Krakow, Poland.
John Paul II Hospital, Krakow, Poland; Department of Electrocardiology, Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland.
Thromb Res. 2015 Oct;136(4):832-8. doi: 10.1016/j.thromres.2015.08.007. Epub 2015 Aug 16.
Atrial fibrillation (AF) increases the risk of thromboembolism that is reduced by vitamin K antagonists (VKAs). We sought to investigate changes in plasma fibrin clot phenotype at the onset of oral anticoagulation.
Forty consecutive AF patients (aged 45-83 years, CHA2DS2-VASc score 3.0±1.5) who started therapy with warfarin or acenocoumarol were studied. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), along with clotting factors (F), thrombin generation (TG) profiles and protein C (PC) levels were determined on days 3, 5, 7, 28 and 56±1 since the first dose.
AF patients had 16% higher median of Ks and 15% lower median of CLT as early as on day 3 of VKA therapy compared with the baseline (both p<0.001), reaching the plateau values on day 7 and 5, respectively. Higher Ks values on days 1 and 3 were found in AF patients with further stable anticoagulation (both p<0.05). Moreover, FIX explained 32% of the total variability in Ks. Multivariate analysis adjusted for potential confounders including time as a predictor showed that vitamin K-dependent (VKD) factors, PC and TG parameters were the predictors of Ks (all p<0.0001), while only the lag phase of TG and thrombin peak predicted CLT (both p<0.05) in AF patients. Regression analysis of time-series showed however, that CLT was also predicted by VKD factors and PC (all p<0.05).
Plasma fibrin clot properties in AF patients are favourably modified as early as after 3days of VKA administration, which might contribute to antithrombotic effectiveness.
心房颤动（AF）会增加血栓栓塞的风险，维生素 K 拮抗剂（VKAs）可降低这种风险。我们试图研究口服抗凝治疗开始时血浆纤维蛋白凝块表型的变化。
连续纳入 40 例 AF 患者（年龄 45-83 岁，CHA2DS2-VASc 评分为 3.0±1.5），这些患者开始使用华法林或醋硝香豆素治疗。在开始抗凝治疗第 3、5、7、28 和 56±1 天，检测血浆纤维蛋白凝块通透性（Ks）、凝块溶解时间（CLT）以及凝血因子（F）、凝血酶生成（TG）谱和蛋白 C（PC）水平。
与基线相比，AF 患者在 VKA 治疗第 3 天即有 16%的 Ks 中位数升高和 15%的 CLT 中位数降低（均 P<0.001），分别在第 7 天和第 5 天达到平台值。在进一步稳定抗凝的 AF 患者中，第 1 天和第 3 天的 Ks 值更高（均 P<0.05）。此外，FIX 解释了 Ks 总变异性的 32%。多变量分析调整了包括时间在内的潜在混杂因素，结果显示维生素 K 依赖性（VKD）因子、PC 和 TG 参数是 Ks 的预测因子（均 P<0.0001），而只有 TG 的滞后期和凝血酶峰值预测了 CLT（均 P<0.05）。然而，时间序列的回归分析表明，CLT 也可由 VKD 因子和 PC 预测（均 P<0.05）。
AF 患者的血浆纤维蛋白凝块特性在 VKA 给药后 3 天即可得到有利改善，这可能有助于抗血栓形成的效果。
