CARDIOVASCULAR MEDICINE

Plasma von Willebrand factor, soluble thrombomodulin, and fibrin D-dimer concentrations in acute onset non-rheumatic atrial fibrillation

F Marín¹, V Roldán², V E Climent¹, A Ibáñez¹, A García¹, P Marco³, F Sogorb¹, G Y H Lip⁴

¹ Department of Cardiology, General Hospital of Alicante, Alicante, Spain
² Haematology Unit, Hospital of San Vicente, Alicante, Spain
³ Department of Haematology, General Hospital of Alicante, Alicante, Spain
⁴ Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

Correspondence to:
Correspondence to:
Dr F Marín
Department of Cardiology, General Hospital of Alicante, Pintor Baeza s/n, Alicante 03002, Spain; fcomarino{at}hotmail.com

Objective: To investigate whether new onset acute atrial fibrillation (AF) of < 48 hours’ duration creates a prothrombotic state in the absence of anticoagulation and to assess the evolution in research indices after spontaneous or pharmacological cardioversion.

Methods: 24 patients were recruited with first onset acute non-rheumatic AF, in whom sinus rhythm was restored within 48 hours of arrhythmia onset, without anticoagulant treatment. Atrial mechanical function was assessed by transmitral inflow. Soluble thrombomodulin and von Willebrand factor concentrations (both as indices of endothelial damage or dysfunction) and fibrin D-dimer concentrations (as an index of thrombogenesis) were measured. Blood samples were drawn and echocardiographic studies were performed at days 1, 3, 7, and 30 after cardioversion. Research indices were compared with those of 24 healthy participants, 24 patients with chronic AF, and 24 patients with ischaemic heart disease in sinus rhythm.

Results: Patients with AF had higher concentrations of soluble thrombomodulin (acute AF 12.1 (4.1) ng/ml; chronic AF 11.8 (4.6) ng/ml), von Willebrand factor (acute AF 137.2 (36.9) ng/ml; chronic AF 133.1 (25.0) ng/ml), and fibrin D-dimer concentrations (acute AF 2.35 (2.68) µg/ml; chronic AF 1.12 (0.65) µg/ml) than did healthy controls (5.9 (2.7) ng/ml, 86.7 (33.2) ng/ml, and 0.39 (0.28) µg/ml, respectively) and patients with ischaemic heart disease (7.4 (3.7) ng/ml, 110.0 (29.0) ng/ml, and 0.99 (0.73) µg/ml, respectively) (all p < 0.05). Day 30 concentrations of fibrin D-dimer were higher in patients with acute AF than in patients with chronic AF (p = 0.038) but sTM and von Willebrand factor concentrations were not different (both not significant). There were no significant changes in research indices or echocardiographic parameters after cardioversion (all p > 0.05).

Conclusions: There was evidence among patients with acute onset AF of endothelial damage or dysfunction and increased thrombogenesis, which persisted up to 30 days after cardioversion.

Abbreviations: AF, atrial fibrillation; ELISA, enzyme linked immunosorbent assay; sTM, soluble thrombomodulin; vWf, von Willebrand factor

Keywords: acute atrial fibrillation; cardioversion; endothelial damage; hypercoagulability

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