Relationship between koagulation , agragation, fibrinolitic systems markers and presence of intracardiac thrombus in patients with atrial fibilation

Atrial fibrillation (AF) is the most common continuous rhythm disorder worldwide. Thrombosis developing on the basis of AF is a pathology which has important place in the etiology of stroke. In this study, we aimed to find a noninvasive marker that can predict the presence of thrombus by examining the relationship between the presence of thrombus and beta-thromboglobulin (β-TG), prothrombin fragment 1-2 (PF1-2), thrombin-antithrombin complexes (TAT), tissue plasminogen activator / plasminogen activator inhibitor (tPA-PAI-1) complexes, D-Dimer ( DD) levels. In this study, by using transesophageal echocardiography, thrombus detected 14 patients and trombus not detected 40 patients were evaluated. The correlation between the presence of thrombus and thromboembolic risk scores, β-TG, PTF 1-2, thrombin-antithrombin complex, t-PA-PAI-1 complex, DD levels was examined. The mean age of patients was 65.6 ± 12.2 years. There was no significant relationship between age and the presence of thrombus. 33 patients (61.1%) were male and male patients had a higher incidence of thrombosis (p <0.05). While there was no relationship between thrombus and hypertension (HT), diabetes mellitus (DM), old cerebrovascular accident (CVA), hyperlipidemia, malignancy, thyroid disease, smoking status in patiens; heart failure, peripheral artery disease, coronary artery disease (PAD-CAD) and chronic obstructive pulmonary disease (COPD) were observed more frequently in patients with thrombus (p <0.05). There was no relationship between atrial size and the presence of thrombus. While CHADS2 s score of patients with thrombosis was significantly higher (p <0.05); a statistically significant association was not detected between the presence of thrombus and CHA2DS2-VASc score. Patients' DD median value was 0.33 (range: 2.06), TAT median value was 88150 (range: 497 350), tPA / PAI-I median value was 14.1 (range: 14.92), β-TG median value was 10359, 5 (range: 28541.5) and PTF 1-2 median value 13880 (range: 530 420) respectively. There was not a statistically significant relationship between presence of thrombus and DD, TAT, tPA / PAI-I, β-TG, PTF 1-2 levels (p> 0.05). In patients included the study; appropriate cut-off value for DD 0,2 , sensitivity 91.7%, specificity 47.9% ; appropriate cut-off value for TAT 83875 , sensitivity 71,4%, specificity 46,2% ; appropriate cut-off value for tPA/PAI-I 12,74 , sensitivity 78,6%, specificity 41,0% ; appropriate cut-off value for β-TG 8233,5 , sensitivity 85,7%, specificity 33,3% ; appropriate cut-off value for PTF 1-2 6310 , sensitivity 78,6%, specificity 15,4% detected respectively. As a result, DD, TAT, tPA / PAI-I, β-TG and PTF1-2 markers are not specific markers that can be used in the diagnosis of thrombus formation in patients with atrial fibrillation. However, considering of limitations in the number of cases in our series, thrombus formation process and undetected coagulation disorders; it can be said that comprehensive studies are needed. Key words: atrial fibrillation, thrombosis, coagulation disorders