Effect of Warfarin on Regional Left Atrial Coagulation Activity in Mitral Stenosis

Increased regional left atrial (LA) coagulation activity has recently been implicated in the pathophysiology of LA thrombus and systemic embolism in mitral stenosis (MS). Anticoagulation with warfarin reduces the risk of such thromboembolism, but the effect of warfarin on LA coagulation activity is...

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Bibliographic Details
Published in:The American journal of cardiology 1997-02, Vol.79 (3), p.339-343
Main Authors: Peverill, Roger E, Harris, Geoffrey, Gelman, John, Gan, T.Eng, Harper, Richard W, Smolich, Joseph J
Format: Article
Language:English
Subjects:
Aged
Anticoagulants - pharmacology
Biological and medical sciences
Blood Coagulation - drug effects
Blood. Blood coagulation. Reticuloendothelial system
Cardiovascular disease
Catheterization
Coronary vessels
Drug therapy
Echocardiography
Female
Heart Atria
Humans
Male
Medical research
Medical sciences
Middle Aged
Mitral Valve Stenosis - blood
Mitral Valve Stenosis - diagnostic imaging
Mitral Valve Stenosis - drug therapy
Mitral Valve Stenosis - therapy
Pharmacology. Drug treatments
Warfarin - pharmacology
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Summary:Increased regional left atrial (LA) coagulation activity has recently been implicated in the pathophysiology of LA thrombus and systemic embolism in mitral stenosis (MS). Anticoagulation with warfarin reduces the risk of such thromboembolism, but the effect of warfarin on LA coagulation activity is unknown. We have addressed this question in MS patients with normal or prolonged clotting times. Peripheral venous and LA coagulation activities were measured in MS patients on long-term oral anticoagulation, who were predisposed to increased LA coagulation activity because of the presence of LA spontaneous echo contrast. Patients ceased warfarin 4 days before percutaneous balloon mitral valvuloplasty, and had either a normal (n = 15) or prolonged (n = 8) International Normalized Ratio (INR) at valvuloplasty. Coagulation activity was assessed during the valvuloplasty procedure, but before valve dilation, by measuring levels of prothrombin fragment 1 +2 (F1 + 2), a marker of thrombin generation. The LA F1 + 2 level exceeded the peripheral venous level in patients with a normal INR (p
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(96)00758-8