Assessment of Coagulation Factors in Patients With Severe Rheumatic Mitral Stenosis in Sinus Rhythm With Left Atrial Appendage Inactivity

BackgroundPatients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC), are prone to left atrial (LA) or LAA thrombus formation. But unlike atrial fibrillation (AF), oral anticoagulants (OAC) are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR and healthy controls.MethodsThe study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC eligible for balloon mitral valvuloplasty and 35 controls. All patients underwent transthoracic and trans-esophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, with blood samples analysed for procoagulant levels.ResultsResults showed comparable baseline characteristics between groups, with most patients in NYHA II or III functional classes and varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1+2 {patient vs control, 9017(6228.0-10963.5)pg/mL vs 1790(842.3-2712)pg/mL, p<0.0001)}, thrombin-antithrombin III {patient vs control, 39(5.45-74.85)ng/ml vs 2.80(1.6-6.5)ng/mL, p<0.0001}, plasminogen activator inhibitor-1 {patients vs controls, 26.09±8.18ng/mL vs 8.05±3.53ng/mL, p<0.0001)}, and fibrinogen (3.48±0.89g/L vs 3.01±0.53g/L, p=0.029) in the LA of patients compared to controls. Systemic procoagulant levels were also elevated in patients, but D-dimer levels were similar between the two groups.ConclusionThe findings suggest a hypercoagulable state in patients similar to those with AF. The study advocates for consideration of OAC in these patients until LA and LAA function improve to mitigate thrombus formation.