A proportion of patients with mitral stenosis have increased left atrial thrombin generation, with elevated left atrial but normal peripheral venous levels of prothrombin fragment 1+2 (F1+2). Whether this pattern of left atrial and venous F1+2 levels is related to limited spillover of F1+2 from the left atrium into the systemic circulation, or to washout of increased left atrial F1+2 production into the arterial circulation with subsequent systemic clearance, is unclear. We examined the relationship between arterial and venous F1+2 levels in mitral stenosis patients without left atrial thrombus. The study group comprised 36 patients with either a normal (n = 29) or prolonged (n = 7) international normalized ratio (INR; a measure of clotting time) who were undergoing percutaneous balloon mitral valvuloplasty. Baseline arterial and venous blood samples were collected at the beginning of the valvuloplasty procedure, and left atrial and venous samples were collected after trans-septal puncture. The left atrial F1+2 level exceeded the corresponding venous level in patients with a normal INR (P < 0.03); however, baseline arterial and venous F1+2 levels were similar. Arterial and venous F1+2 levels were also similar in the subgroup of patients with evidence of a regional increase in left atrial thrombin generation, and were not different from arterial and venous F1+2 levels in patients without such an increase. Baseline arterial and venous F1+2 levels were both lower in the presence of a prolonged INR. Thus the pattern of increased left atrial but normal venous F1+2 levels in mitral stenosis is due to limited spillover from the left atrium into the systemic circulation.
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March 22 2000
Increased left atrial thrombin generation in mitral stenosis is not reflected in arterial prothrombin fragment 1+2 levels
Roger E. PEVERILL;
*Centre for Heart and Chest Research, Department of Medicine, Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
Correspondence: Dr Roger E. Peverill, Cardiology Unit, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia (e-mail [email protected]).
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Richard W. HARPER;
Richard W. HARPER
*Centre for Heart and Chest Research, Department of Medicine, Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
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T. Eng GAN;
T. Eng GAN
†Haematology Unit, Monash Medical Centre, Melbourne, Victoria, Australia
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Joseph J. SMOLICH
Joseph J. SMOLICH
*Centre for Heart and Chest Research, Department of Medicine, Monash University and Monash Medical Centre, Melbourne, Victoria, Australia
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Publisher: Portland Press Ltd
Received:
August 04 1999
Revision Received:
October 19 1999
Accepted:
January 13 2000
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society and the Medical Research Society © 2000
2000
Clin Sci (Lond) (2000) 98 (4): 501–506.
Article history
Received:
August 04 1999
Revision Received:
October 19 1999
Accepted:
January 13 2000
Citation
Roger E. PEVERILL, Richard W. HARPER, T. Eng GAN, Joseph J. SMOLICH; Increased left atrial thrombin generation in mitral stenosis is not reflected in arterial prothrombin fragment 1+2 levels. Clin Sci (Lond) 1 April 2000; 98 (4): 501–506. doi: https://doi.org/10.1042/cs0980501
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