Views: 1,522 | Downloads:
22
| Responses: 0
| XML | Respond to this article | Alert & updates | Request permissions | Email to a friend |
Original ArticleOpen Access
An Abnormal Systemic and Regional Hypercoagulable State in Patients with Mitral Stenosis
Phankingthongkum R 
,
Opartkiattikul N ,
Chotinaiwattarakul C ,
Panchavinnin P ,
Tresukosol D ,
Jakrapanichakul D ,
Krittayaphong R ,
Kitrattana B ,
Thongtang V
,
Opartkiattikul N ,
Chotinaiwattarakul C ,
Panchavinnin P ,
Tresukosol D ,
Jakrapanichakul D ,
Krittayaphong R ,
Kitrattana B ,
Thongtang V NISARAT OPARTKIATTIKUL, MD**,
PRADIT PANCHAVINNIN, MD*,
DECHO JAKRAPANICHAKUL, MD*,
BUSSAKORN KITRA TT ANA, BSc*,
Mitral stenosis still remains a major problem in Southeast Asia including Thailand. It contri-
butes to the morbidity and mortality related to thromboembolism which was associated with the left
atrial thrombus. However, the pathogenesis of left atrial thrombus in these patients is not completely
understood. Therefore, the objective of this study was to investigate the coagulation and platelet activity
including the function of the endocardium in the left atrium and peripheral circulation in patients with
mitral stenosis who were free of left atrial thrombus and to compare those hematologic markers activity
in the peripheral venous blood between the patients with mitral stenosis and the control.
Thirty-six patients with moderate to severe mitral stenosis were included in the study. Most
of the patients were in functional class II and 50 per cent had atrial fibrillation. Blood was obtained
from the femoral vein, femoral artery, pulmonary artery and left atrium of these patients before heparin
was administered to determine the value of various hematologic markers. In the control group, blood
for determining the hematologic markers was collected only from the antecubital vein. The results of
this study demonstrated that the levels of prothrombin activation fragment 1 +2 (Fl +2), thrombin-anti-
thrombin III complex (TAT) and Beta-thromboglobulin ((3-TG) in the left atrium of the patients with
mitral stenosis were significantly higher than those in the femoral vein and femoral artery, whereas the
level of thrombomodulin was significantly lower in the left atrium compared with the femoral artery and
vein. When comparing with the control group, the levels ofT AT, plasminogen activator inhibitors-I
(PAI-l) from the peripheral vein were significantly higher and the level of thrombomodulin was also
significantly lower in the patients with mitral stenosis.
Vol. 87 No.2
SYSTEMIC AND REGIONAL HYPERCOAGULABLE STATE IN MITRAL STENOSIS
159
In conclusion, the present study demonstrated an abnormal hypercoagulable state of the left
atrium and systemic circulation related to the abnormalities of coagulation, platelets and the endo-
cardium which may cause the formation of left atrial thrombus in patients with mitral stenosis.
Key word : Mitral stenosis, Coagulation, Platelet, Thrombus, Hypercoagulable State
PRADIT PANCHAVINNIN, MD*,
DECHO JAKRAPANICHAKUL, MD*,
BUSSAKORN KITRA TT ANA, BSc*,
Mitral stenosis still remains a major problem in Southeast Asia including Thailand. It contri-
butes to the morbidity and mortality related to thromboembolism which was associated with the left
atrial thrombus. However, the pathogenesis of left atrial thrombus in these patients is not completely
understood. Therefore, the objective of this study was to investigate the coagulation and platelet activity
including the function of the endocardium in the left atrium and peripheral circulation in patients with
mitral stenosis who were free of left atrial thrombus and to compare those hematologic markers activity
in the peripheral venous blood between the patients with mitral stenosis and the control.
Thirty-six patients with moderate to severe mitral stenosis were included in the study. Most
of the patients were in functional class II and 50 per cent had atrial fibrillation. Blood was obtained
from the femoral vein, femoral artery, pulmonary artery and left atrium of these patients before heparin
was administered to determine the value of various hematologic markers. In the control group, blood
for determining the hematologic markers was collected only from the antecubital vein. The results of
this study demonstrated that the levels of prothrombin activation fragment 1 +2 (Fl +2), thrombin-anti-
thrombin III complex (TAT) and Beta-thromboglobulin ((3-TG) in the left atrium of the patients with
mitral stenosis were significantly higher than those in the femoral vein and femoral artery, whereas the
level of thrombomodulin was significantly lower in the left atrium compared with the femoral artery and
vein. When comparing with the control group, the levels ofT AT, plasminogen activator inhibitors-I
(PAI-l) from the peripheral vein were significantly higher and the level of thrombomodulin was also
significantly lower in the patients with mitral stenosis.
Vol. 87 No.2
SYSTEMIC AND REGIONAL HYPERCOAGULABLE STATE IN MITRAL STENOSIS
159
In conclusion, the present study demonstrated an abnormal hypercoagulable state of the left
atrium and systemic circulation related to the abnormalities of coagulation, platelets and the endo-
cardium which may cause the formation of left atrial thrombus in patients with mitral stenosis.
Key word : Mitral stenosis, Coagulation, Platelet, Thrombus, Hypercoagulable State
Download:
PDF