The exact mechanisms for thrombus formation in patients with valvular heart disease have not been clearly defined. Abnormalities in plasma coagulation factors indicative of a prothrombotic state may in part account for the risk of stroke and thromboembolism in such patients. The aim of this study was, therefore, to determine the effects of mitral regurgitation (MR) and aortic stenosis (AS) on plasma fibrinogen or fibrin D-dimer levels as indices of a thrombogenic (or prothrombotic) state. A total of 25 patients with valve disease in sinus rhythm were studied: 12 patients (all women; mean age fifty-five years, sem 3.3) with MR; and 13 patients (7 men, 6 women; mean age fifty-seven years, sem 3.5) with AS were studied. Patients with MR had a median plasma fibrinogen that was significantly elevated when compared with female population values (median difference 0.62 g/L; 95% confidence intervals (CI) 0.27 to 1.05, P = 0.0016). However, these patients had a median plasma fibrin D-dimer that was lower than that for population controls (median difference 21 ng/mL; 95% CI 0 to 38, P = 0.05). Patients with aortic valve disease had a median plasma fibrinogen that was significantly increased when compared with population controls (median (continued on next page) difference 0.82 g/L; 95% CI 0.34 to 1.24, P = 0.001). These patients had a plasma fibrin D-dimer level that was similar to population values (median difference 3 ng/mL; 95% CI -25 to 22, P = 0.80). Patients with MR or AS have higher plasma fibrinogen levels when compared with "normal" population values, suggesting possible hemorheologic abnormalities in these patients. Subjects with MR had lower plasma fibrin D-dimer levels, suggesting lesser intravascular clotting, consistent with clinical echocardiographic studies. Subjects with AS had plasma fibrin D-dimer levels similar to the "normal" population values, suggestive of a different pathophysiological mechanism for thromboembolism. These findings add to an improved understanding of the relationship between clinical observations and the signif icance of plasma fibrinogen and fibrin D-dimer levels in thrombogenesis.

1 Anticoagulant therapy with warfarin is now established as effective thromboprophylaxis against stroke in atrial fibrillation, in high-risk persons. Aspirin is indicated in moderate-risk persons or if warfarin is contraindicated.2 Risk stratification is suggested, using clinical factors supplemented by echocardiography, to aid choice of prophylaxis.3 Further studies are required to establish how best to identify undiagnosed patients who have atrial fibrillation; to develop new therapeutic strategies; and to refine risk stratification to define which patients with atrial fibrillation are at the highest risk of stroke.

Conference Abstract| February 01 1994 Does Endothelial Dysfunction Contribute to Thrombogenesis in Patients with Chronic Atrial Fibrillation? GYH Lip; GYH Lip 1Department of Cardiology, University Department of Medicine. Royal Infirmary, Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar D Smith; D Smith *Department of Haematology, University Department of Medicine. Royal Infirmary, Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar GDO Lowe; GDO Lowe **Department of Stobhill Hospital, University Department of Medicine. Royal Infirmary, Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar F G Dunn F G Dunn 1Department of Cardiology, University Department of Medicine. Royal Infirmary, Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1994) 86 (s30): 34P. https://doi.org/10.1042/cs086034Pa Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation GYH Lip, D Smith, GDO Lowe, F G Dunn; Does Endothelial Dysfunction Contribute to Thrombogenesis in Patients with Chronic Atrial Fibrillation?. Clin Sci (Lond) 1 February 1994; 86 (s30): 34P. doi: https://doi.org/10.1042/cs086034Pa Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1994 The Biochemical Society and the Medical Research Society1994 Article PDF first page preview Close Modal You do not currently have access to this content.

Plasma fibrinogen and white blood cell count were compared in fifty patients aged 25-50 years with periodontal disease and in fifty age-matched controls with relatively healthy periodontal tissues. Patients had significantly higher levels of fibrinogen and white cell count, and dental indices correlated significantly with these two cardiovascular risk factors on multivariate analyses. We suggest that inflammatory dental disease may be a determinant of fibrinogen level and white cell count in the general population, and that fibrinogen and white cell count may be two mediators of the link between dental disease and myocardial infarction.

Conference Abstract| March 01 1993 Effect of Warfarin and Aspirin Therapy on Plasma Fibrinogen and Fibrin d-Dimer levels in Patients with chronic Atrial Fibrillation GYH Lip; GYH Lip 1Department of Cardiology, Stobhill Hospital, Glasgow Search for other works by this author on: This Site PubMed Google Scholar A Rumley; A Rumley *University Department of Medicine, Royal Infirmary Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar MJ Metcalfe; MJ Metcalfe 1Department of Cardiology, Stobhill Hospital, Glasgow Search for other works by this author on: This Site PubMed Google Scholar FG Dunn; FG Dunn 1Department of Cardiology, Stobhill Hospital, Glasgow Search for other works by this author on: This Site PubMed Google Scholar GDO Lowe GDO Lowe *University Department of Medicine, Royal Infirmary Glasgow, Scotland Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1993 The Biochemical Society and the Medical Research Society1993 Clin Sci (Lond) (1993) 84 (s28): 17P. https://doi.org/10.1042/cs084017Pa Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation GYH Lip, A Rumley, MJ Metcalfe, FG Dunn, GDO Lowe; Effect of Warfarin and Aspirin Therapy on Plasma Fibrinogen and Fibrin d-Dimer levels in Patients with chronic Atrial Fibrillation. Clin Sci (Lond) 1 March 1993; 84 (s28): 17P. doi: https://doi.org/10.1042/cs084017Pa Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1993 The Biochemical Society and the Medical Research Society1993 Article PDF first page preview Close Modal You do not currently have access to this content.