Key result
Patients with mitral stenosis and sinus rhythm with left atrial spontaneous echo contrast exhibit coagulation and platelet activation similar to those with atrial fibrillation (p<0.05 vs controls).
Why the study?
Are there hemostatic changes indicating coagulation activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm compared to those with atrial fibrillation and controls?
Observational (n=46)
Are there hemostatic changes indicating coagulation activation and endothelial dysfunction in patients with mitral stenosis and sinus rhythm compared to those with atrial fibrillation and controls?
p-value: p=<0.05
Patients with mitral stenosis and sinus rhythm, particularly those with left atrial spontaneous echo contrast, exhibit coagulation and platelet activation similar to those with atrial fibrillation, suggesting a potential role for anticoagulation.
Hypothesis-generating for anticoagulation in mitral stenosis sinus rhythm with spontaneous echo contrast; randomized trials needed before practice change.
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.
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Topaloğlu et al. (2007) conducted an observational in Mitral stenosis (n=46). Mitral stenosis with sinus rhythm or atrial fibrillation vs. Control group was evaluated on Systemic venous fibrinogen, D-dimer, antithrombin-III, tPA, PAI-I, vWF, and PF 4 levels (p=<0.05). Patients with mitral stenosis and sinus rhythm with left atrial spontaneous echo contrast exhibit coagulation and platelet activation similar to those with atrial fibrillation (p<0.05 vs controls).
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