fibrinopeptide-a and Heart-Diseases

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and may cause systemic embolization resulting in serious and fatal complications. Several clinical techniques are used to detect the presence of LA thrombi, but even echocardiography, the most widely used, has some drawbacks depending on the sizes and locations of the thrombi. This study evaluated D-dimer, fibrinopeptide A(FPA), and thrombin-antithrombin III complex (TAT) as molecular markers for diagnosing the presence of LA thrombi in 26 patients with MS who underwent cardiac surgery. Atrial fibrillation was detected in all patients. Patients with episodes of obvious thromboembolic diseases were excluded. Blood was obtained from the brachial vein before the surgery (3 +/- 1 days; mean +/- SD). The presence or absence of thrombi was confirmed at surgery in all patients. Levels of both D-dimer and TAT were significantly higher in patients with thrombi than in those without thrombi or in normal subjects. FPA levels did not differ significantly between the three groups. The levels of D-dimer and TAT correlated significantly with the weights of the LA thrombi. LA thrombi (ca > or = 2 g) were always confirmed at surgery in patients with levels of D-dimer higher than 200 ng/ml and/or levels of TAT higher than 4 ng/ml. These results indicate that D-dimer and TAT are simple and useful diagnostic markers for determining LA thrombi in patients with MS.

Topics: Antithrombin III; Biomarkers; Echocardiography; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Heart Diseases; Humans; Male; Middle Aged; Mitral Valve Stenosis; Peptide Hydrolases; Thrombosis

Venous thrombosis is a relatively usual but serious complication of permanent transvenous pacing. However, the pathogenesis has not been defined. To clarify underlying abnormalities in the coagulation-fibrinolysis system in patients with permanent transvenous pacemakers, we measured serum levels of fibrinopeptide A (FPA), thrombin-antithrombin III complexes (TATs), plasmin-alpha 2 plasmin inhibitor complexes (PICs), D-dimer (D-D), beta-thromboglobulin (beta-TG), and platelet factor 4 (PF4) in 53 patients with permanent transvenous pacemakers and 10 control subjects. The patients were divided into two groups, as follows, according to the presence of mural thrombus documented along the pacing lead(s) by digital subtraction angiography and transesophageal echocardiography: Group Th (-), patients without venous route thrombus; and Group Th (+), patients with venous route thrombus. FPA and TAT levels increased significantly even in Group Th (-), and further increased in Group Th (+) compared with control subjects (FPA: 7.5 +/- 4.9, 15.3 +/- 8.8 vs 3.0 +/- 1.4 ng/mL, respectively, P < 0.05; TAT: 2.9 +/- 1.3, 4.8 +/- 2.3 vs 1.7 +/- 0.6 ng/mL, respectively, P < 0.05). There were no differences in levels of D-D, PIG, beta-TG, and PF4 among control subjects, Group Th (-), and Group Th (+). These findings suggest that the hypercoagulable state appears in patients with permanent transvenous pacemakers, even without apparent venous thrombosis. The patients with permanent transvenous pacemakers are thought to be in the prethrombotic state even if they have no venous route thrombosis.

Topics: Adult; Aged; Aged, 80 and over; alpha-2-Antiplasmin; Angiography, Digital Subtraction; Antifibrinolytic Agents; Antithrombin III; beta-Thromboglobulin; Blood Coagulation; Cardiac Pacing, Artificial; Echocardiography, Transesophageal; Female; Fibrin Fibrinogen Degradation Products; Fibrinolysin; Fibrinolysis; Fibrinolytic Agents; Fibrinopeptide A; Heart Diseases; Humans; Male; Middle Aged; Pacemaker, Artificial; Peptide Hydrolases; Platelet Factor 4; Serine Proteinase Inhibitors; Thrombophlebitis; Thrombosis

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and the systemic embolization due to thrombi causes a serious, occasionally fatal complication. Several clinical techniques have been used to estimate the presence of LA thrombi. However, the hitherto available methods, even an echocardiography which has been most widely used, still have some drawbacks, depending on the size and location of thrombi. The author measured D-dimer, fibrinopeptide A (FPA) and thrombin-antithrombin III complex (TAT) in the patients with MS and evaluated the diagnostic value of these molecular markers to estimate the presence of LA thrombi. Twenty six patients with MS who had undergone cardiac operation were studied. Atrial fibrillation was found in all the patients. Episode of obvious thromboembolic diseases is a criteria of exclusion. Blood was drawn from the brachial vein several days (3 +/- 1 days: mean +/- SD) before the operation. The presence or absence of thrombus was confirmed at the surgery in all the cases. 1) Both levels of D-dimer and TAT were significantly higher in the patients with thrombi than those in the patients without thrombus or those in normal controls (mean: 378, 93 and 64 ng/ml, respectively; p less than 0.01 for both and 9.1, 2.0 and 1.7 ng/ml, respectively; p less than 0.01 for both). However, levels of FPA were not significantly different among the three groups (mean: 7.9, 4.9 and 3.7 ng/ml, respectively; NS for both). 2) both levels of D-dimer and TAT were significantly correlated with the weights of LA thrombus (r = 0.87, p less than 0.01: r = 0.79, p less than 0.01, respectively). 3) LA thrombi (ca. greater than or equal to 2 g) were always confirmed at the surgery in the patients who had levels of D-dimer higher than 200 ng/ml and/or TAT higher than 4 ng/ml. The plasma levels of D-dimer and TAT were further followed after the surgery in the same 18 patients (8 patients who had thrombus, the rest who didn't). 1) In the patients who had thrombi, levels of D-dimer were significantly decreased after the surgery (mean: from 267 ng/ml to 73 ng/ml, p less than 0.05). Levels of TAT were slightly but not significantly decreased (mean: from 82 ng/ml to 76 ng/ml, NS).(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Aged; Antithrombin III; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Heart Atria; Heart Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve Stenosis; Peptide Hydrolases; Thrombosis; Warfarin

Using two-dimensional echocardiography, we studied the pathophysiology of intracardiac thrombus regression accompanied by anticoagulant therapy in 82 consecutive patients with acute cardiogenic cerebral embolism. We noted intracardiac thrombus in 15 patients; nine of the 15 were started on anticoagulant therapy with warfarin potassium to maintain the prothrombin time between 2.5 and 3.5 (international normalized ratio). Serial two-dimensional echocardiograms were obtained for these nine patients before and after anticoagulation, with the plasma levels of fibrinopeptide A, fibrinopeptide B beta 15-42, and D-dimer measured at the same time. In eight of the nine patients the intracardiac thrombi gradually decreased in size while the plasma level of fibrinopeptide A fell to within the normal range and the plasma levels of fibrinopeptide B beta 15-42 and D-dimer remained above the normal ranges. In the other patient the thrombus disappeared, with embolization to the right arm immediately after starting anticoagulant therapy. Mobile or small thrombi regressed earlier than nonmobile or large ones. We conclude that regression of intracardiac thrombi after anticoagulation may be based on the relative predominance of plasma fibrinolytic activity over anticoagulation-inhibited thrombin activity.

Topics: Aged; Anticoagulants; Echocardiography; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Fibrinopeptide B; Heart Diseases; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Prothrombin Time; Thrombosis

Plasma fibrinopeptide A levels, beta-thromboglobulin levels and platelet factor 4 levels were estimated by enzyme-linked immunosorbent assay before and after hyperventilation in 12 patients with coronary vasospastic angina and in 12 control subjects matched for age and gender. In all 12 study patients, anginal attacks accompanied by electrocardiographic (ECG) changes (ST elevation in 11 patients and ST depression in 1 patient) were induced by hyperventilation. Coronary angiography was performed on 11 of the 12 patients, and coronary artery spasm with the same ECG changes was induced by intracoronary injection of acetylcholine in all 11. The plasma fibrinopeptide A levels increased significantly from 2.0 +/- 0.4 to 10.0 +/- 2.4 ng/ml during the attack (p less than 0.001) in the study patients, but remained unchanged before and after hyperventilation in the control subjects. The plasma levels of beta-thromboglobulin and platelet factor 4 remained unchanged after hyperventilation in both groups. Our data indicate that coronary artery spasm may induce thrombin generation and trigger thrombus formation in the coronary artery.

Topics: Aged; beta-Thromboglobulin; Coronary Angiography; Coronary Vasospasm; Electrocardiography; Female; Fibrinogen; Fibrinopeptide A; Heart Diseases; Humans; Hyperventilation; Male; Middle Aged; Thrombosis