ACTIVATION OF THE COAGULATION SYSTEM IN WOMEN WITH MITRAL-STENOSIS AND SINUS RHYTHM

Systemic embolism is a frequent complication in mitral stenosis (MS).1 Its incidence increases with age and the presence of atrial fibrillation.2,3 Although patients with MS and sinus rhythm can also develop systemic emboli, the frequency of this event is lower in these patients than in those with atrial fibrillation.1 Patients with MS and atrial fibrillation are considered at high risk of systemic embolism and require anticoagulant therapy.4 Because patients with MS and sinus rhythm are considered at low risk for systemic embolism, anticoagulant therapy is not routinely recommended.4 It is desirable to identify patients with MS in sinus rhythm who are at high risk for systemic embolism. There are no reliable clinical or laboratory parameters available to stratify this risk. Recently developed assays are capable of detecting peptides released during activation of the coagulation cascade and thrombogenesis.5,6 Measurement of these markers may be used to identify patients at risk for thromboembolism. This study was performed to test the hypothesis that there is activation of coagulation in patients with MS and sinus rhythm. Fibrinolytic activity was assayed by measuring D-dimers that are generated from plasmic degradation of cross-linked fibrin.5 Thrombin activation was assayed by measuring thrombinantithrombin III complexes.6. © 1992.