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Coagulation, Fibrinolytic System Activation and Endothelial Dysfunction in Patients With Mitral Stenosis and Sinus Rhythm

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey, topaloglus{at}hotmail.com

Ayca Boyac, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Selime Ayaz, MD

Department of Hematology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Sevinç Yilmaz, MD

Department of Hematology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Oya Yank, MD

Department of Internal Medicine, Ankara Hospital, Ankara, Turkey

Ozcan Ozdemir, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Mustafa Soylu, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Ahmet Duran Demir, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Dursun Aras, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Halil Lutfi Ksack, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

Sule Korkmaz, MD

Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey

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.

Angiology, Vol. 58, No. 1, 85-91 (2007)
DOI: 10.1177/0003319706297917


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