Kahn S R, Solymoss S, Flegel K M
Division of General Internal Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Que.
CMAJ. 1997 Sep 15;157(6):673-81.
To determine whether patients with nonvalvular atrial fibrillation (NVAF) have prothrombotic changes compared with patients in sinus rhythm.
Cross-sectional study. Hemostatic function compared in NVAF patients without prior embolic event (transient ischemic attack or embolic stroke) and control subjects without prior thrombotic stroke, and in NVAF patients with prior embolic event and control subjects with prior thrombotic stroke.
Internal medicine outpatient group practice and anticoagulation clinic in 2 teaching hospitals.
A total of 75 NVAF patients (50 without and 25 with prior embolic event) and 42 control patients (31 without and 11 with prior thrombotic stroke) recruited concurrently over 18 months during 1990-91.
Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and plasma levels of hemoglobin, fibrinogen, von Willebrand factor antigen, factor VIII, fibrin D-dimer, antithrombin III, protein C, protein S, fibrinopeptide A and prothrombin fragment F1+2. All statistical analyses were performed after adjustments for age and sex.
The NVAF patients without a prior embolic event had significantly higher mean hemoglobin and fibrinogen levels (p < 0.001 and p = 0.05, respectively) than the control subjects without prior thrombotic stroke. The 29 NVAF patients not taking warfarin (none had had an embolic event) had significantly lower mean protein C and protein S levels (p = 0.012 and p < 0.001, respectively) and a significantly higher fibrinopeptide A level (p = 0.03, after exclusion of outliers) than the control subjects without prior stroke. The NVAF patients with a prior embolic event had alterations in the hemostatic variables similar to those seen in the control patients with a prior thrombotic stroke. The latter had significantly higher fibrinogen, von Willebrand factor antigen and factor VIII levels (p = 0.04, 0.002 and 0.002, respectively) and significantly lower protein S levels (p = 0.02) than the control subjects without prior stroke.
NVAF patients without a history of an embolic event show evidence of a prothrombotic state compared with patients in sinus rhythm who have not had a thrombotic stroke. NVAF patients with a history of an embolic event show evidence of a prothrombotic state similar to that of patients in sinus rhythm who have had a thrombotic stroke. Prospective studies are needed to determine whether these abnormalities predict higher risk of stroke in individual NVAF patients.
确定与窦性心律患者相比，非瓣膜性心房颤动（NVAF）患者是否存在血栓前状态的改变。
横断面研究。比较无既往栓塞事件（短暂性脑缺血发作或栓塞性卒中）的NVAF患者与无既往血栓性卒中的对照受试者，以及有既往栓塞事件的NVAF患者与有既往血栓性卒中的对照受试者的止血功能。
两家教学医院的内科门诊小组诊所和抗凝门诊。
1990年至1991年期间，在18个月内同时招募了75例NVAF患者（50例无既往栓塞事件，25例有既往栓塞事件）和42例对照患者（31例无既往血栓性卒中，11例有既往血栓性卒中）。
血小板计数、凝血酶原时间（PT）、部分凝血活酶时间（PTT）以及血红蛋白、纤维蛋白原、血管性血友病因子抗原、因子VIII、纤维蛋白D-二聚体、抗凝血酶III、蛋白C、蛋白S、纤维肽A和凝血酶原片段F1+2的血浆水平。所有统计分析均在对年龄和性别进行调整后进行。
无既往栓塞事件的NVAF患者的平均血红蛋白和纤维蛋白原水平显著高于无既往血栓性卒中的对照受试者（分别为p < 0.001和p = 0.05）。29例未服用华法林的NVAF患者（均无栓塞事件）的平均蛋白C和蛋白S水平显著低于无既往卒中的对照受试者（分别为p = 0.012和p < 0.001），纤维肽A水平显著高于对照受试者（排除异常值后p = 0.03）。有既往栓塞事件的NVAF患者的止血变量改变与有既往血栓性卒中的对照患者相似。后者的纤维蛋白原、血管性血友病因子抗原和因子VIII水平显著高于无既往卒中的对照受试者（分别为p = 0.04、0.002和0.002），蛋白S水平显著低于对照受试者（p = 0.02）。
与无血栓性卒中的窦性心律患者相比，无栓塞事件病史的NVAF患者显示出血栓前状态的证据。有栓塞事件病史的NVAF患者显示出与有血栓性卒中的窦性心律患者相似的血栓前状态的证据。需要进行前瞻性研究以确定这些异常是否预示个体NVAF患者发生卒中的风险更高。
