Key result
Paroxysmal atrial fibrillation within the first 24 hours of onset was associated with significantly higher FVIII activity (200.03% vs 109.73%) and vWF levels compared to matched controls.
Why the study?
Paroxysmal atrial fibrillation carries significant embolic risk, but precise hemostatic changes in the very early stage of the disease are not completely studied.
Does paroxysmal atrial fibrillation increase plasma levels and activity of von Willebrand factor and factor VIII in the first 24 hours of clinical manifestation compared to controls in sinus rhythm?
Case-Control (n=103)
No
Does paroxysmal atrial fibrillation increase plasma levels and activity of von Willebrand factor and factor VIII in the first 24 hours of clinical manifestation compared to controls in sinus rhythm?
Absolute Event Rate: 200.03% vs 109.73%
p-value: p=<0.001
Paroxysmal atrial fibrillation induces a hypercoagulable state with increased factor VIII and von Willebrand factor activity within the first 24 hours of onset, independent of CHA2DS2-VASc score.
Supports early hypercoagulability in PAF; hypothesis-generating and leaves open impact on risk stratification.
Introduction Paroxysmal atrial fibrillation (PAF) is a well-documented prothrombotic state that carries significant embolic risk. However, precise hemostatic changes in the very early stage of the disease are not completely studied. The aim of the study was to study von Willebrand factor (vWF) and coagulation factor VIII (FVIII) plasma levels and activity in the first hours (up to 24 h) of PAF clinical manifestation. Material and methods We selected consecutively 51 non-anticoagulated patients (26 men, 25 women, mean age: 59.84 ±1.60) with PAF and 52 controls (26 men, 26 women, mean age: 59.50 ±1.46 years) corresponding in gender, accompanying diseases and conducted treatment. The indicators were examined using enzyme-linked immunoassays and photometric tests. Results All patients were hospitalized between the 2nd and 24th h after the onset of arrhythmia (mean: 8.14 ±0.74 h). Higher FVIII levels (107.52 ±3.48% vs. 93.85 ±2.93%, p < 0.05) and activity (200.03 ±11.11% vs. 109.73 ±4.90%, p < 0.001) were found in the PAF group. vWF levels (178.40 ±12.95% vs. 119.53 ±6.12%, p < 0.001) and activity (200.92 ±12.45% vs. 110.80 ±5.14%, p < 0.001) were also higher. These changes did not depend on age, sex, body mass index or CHA2DS2-VASc score in the PAF group (p > 0.05). PAF duration was a significant predictor of increased FVIII levels and activity. Increased PAF duration was followed by increased values of the factors (r = 0.85, p < 0.001; r = 0.83, p < 0.001). Conclusions The results presented an activated coagulation cascade and endothelial injury, suggesting hypercoagulability still in the early hours of PAF. These changes in PAF did not correlate with CHA2DS2-VASc score risk factors, outlining PAF as a possible independent embolic risk factor.
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Negreva et al. (2020) conducted a case-control in Paroxysmal atrial fibrillation (n=103). Paroxysmal atrial fibrillation vs. Sinus rhythm (controls) was evaluated on FVIII activity (p=<0.001). Paroxysmal atrial fibrillation within the first 24 hours of onset was associated with significantly higher FVIII activity (200.03% vs 109.73%) and vWF levels compared to matched controls.
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