Key result
In aged patients with atrial fibrillation, having four or more abnormal blood coagulation test values was associated with a significantly higher prevalence of left atrial thrombi or aortic plaque compared to having three or fewer abnormal values (72% vs 13%, p<0.01).
Why the study?
Are blood coagulation test abnormalities associated with the presence of left atrial thrombus or aortic plaque in aged patients with atrial fibrillation?
Cross-Sectional (n=61)
No
Are blood coagulation test abnormalities associated with the presence of left atrial thrombus or aortic plaque in aged patients with atrial fibrillation?
Absolute Event Rate: 72% vs 13%
p-value: p=<0.01
Multiple abnormal blood coagulation tests are significantly associated with the presence of left atrial thrombi or aortic plaque in elderly patients with atrial fibrillation.
Does not warrant changes in elderly AF management; leaves open whether coagulation tests predict thromboembolic events.
To screen for risk of embolism, we investigated the association between the presence of left atrial (LA) thrombus by transesophageal echocardiography (TEE) and blood coagulation tests, including thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), plasmin-alpha 2-plasmin inhibitor complex (PIC), D-dimer, tissue plasminogen activator (tPA), free tPA, tPA.PAI-1 complex, prothrombin fragment 1+2 and fibrin degradation product E (FDP-E) in 40 patients with atrial fibrillation (Af) (13 males, 27 females, mean age 76 +/- 8 yrs). Blood coagulation tests were performed in 21 control subjects with sinus rhythm (12 males, 9 females, mean age 75 +/- 4 yrs). LA thrombi were detected in the appendage of 8 patients and in the atrium of 6 patients. Severe atherosclerotic plaque with thrombi in the thoracic aorta were detected in 6 patients without LA thrombi. FDP-E, D-dimer and PIC increased significantly in patients with LA thrombi or aortic plaque in comparison with controls with sinus rhythm. In patients with Af, 25 of them (group A) has more than 4 abnormal coagulation values out of 9 tests and 15 of them (group B) had abnormalities in less than 3 tests. LA thrombi or aortic plaque were detected in 18 patients in group A and 2 patients in group B (72% vs 13%, p < 0.01). In 4 of 6 patients with large LA thrombi, the thrombi were resolved after administration of warfarin. Before administration of warfarin, tPA, PA-1 and tPA.PA-1 complex levels were higher in the two patients whose thrombi did not resolve.(ABSTRACT TRUNCATED AT 250 WORDS)
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Sakai et al. (1994) conducted a cross-sectional in Atrial Fibrillation (n=61). Presence of ≥4 abnormal blood coagulation test values vs. Presence of ≤3 abnormal blood coagulation test values was evaluated on Detection of left atrial thrombi or severe atherosclerotic aortic plaque (p=<0.01). In aged patients with atrial fibrillation, having four or more abnormal blood coagulation test values was associated with a significantly higher prevalence of left atrial thrombi or aortic plaque compared to having three or fewer abnormal values (72% vs 13%, p<0.01).
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