| Objectives:The aims of the study were to observe PAI-1 and D-dimer levels in NVAF patients, investigate the variation tendency of PAI-1 and D-dimer leves along with the anticoagulant therapy, analyze the clinical factors affecting PAI-1 and D-dimer levels, and explicit the role of fibrinolysis system in the formation of hypercoagulable state with NVAF patients, We anticipated this research may provide further study in screening high risk populations and monitoring the safety of anticoagulant therapy in NVAF.Methods:There were two groups in this study, group 1:NVAF patients (n=25)with one or several risk factors(except for hypertension): age≥75, history of stroke or thromboembolism, diabetes mellitus; group 2:Sinus rhythm group with hypertension as control group. ELISA method was used to detect the plasm levels of PAI-1 and D-dimer in the two groups. The difference of PAI-1, D-dimer levels in two groups and the clinical factors affecting PAI-1 and D-dimer levels, the variation tendency of the two indexs along with anticoagulant therapy, and the correlation among PAI-1, D-dimer and INR were analyzed.Results:1. In the two groups, there was no difference in the laboratory basic information, age was imbalanced in the two groups, but multivariate analysis found age had no association with PAI-1 or D-dimer levels. The levels of PAI-1 and D-dimer in AF group were higher than that in control group.2. Colleting the data of PAI-1 and D-dimer levels at all anticoagulant therapy time points (the 1st day,7th day,1st month,2nd month) in NVAF group, The plasm levels of PAI-1 and D-dimer had significant changes in each time points (p=0.000, p=0.000). The decreased percentage of PAI-1 concentration were 7%,18%,31%, respectively; for D-dimer were 19%,34%,43%. No difference was found for PAI-1 leval in AF group at two time points (the 1st day,7th day). The variation of D-dimer levels had significant difference at each two time points.3. The variation of PAI-1 level had no difference between control group and AF group (the 7th days) (p>0.05), difference was found between control group and AF group (the 1st month,2nd month) (p< 0.05); The variation of D-dimer level had no difference between control group and AF group (the 2nd month) (p>0.05), difference was found between control group and AF group (the 7th days,1st month).4. Analyzing the clinical factors affecting PAI-1 and D-dimer levels. PAI-1 level was higher in the patients with history of cigarette smoking, thromoembolism, coronary heart disease than those who didn't have these risk factors, PAI-1 was correlated with history of cigarette smoking, thromoembolism, coronary heart disease (rs were 0.233,0.302,0.306, respectively)(P<0.05). The history of thromoembolism was a independent predictor for PAI-1 level. D-dimer level was higher in the patients with history of cigarette smoking, thromoembolism, diabetes mellitus, coronary heart disease, D-dimer was correlated with history of cigarette smoking, thromoembolism, diabetes mellitus, coronary heart disease (rS were 0.366,0.419,0.325,0.484 respectively) (P<0.05). The history of thromoembolism and coronary heart disease were independent predictors for D-dimer level.5. Analyzing the relation among PAI-1, D-dimer and INR. PAI-1 and D-dimer leves were different at different INR levels(INR≤2.0 and INR >2.0). PAI-1 and D-dimer levels were higher in INR≤2.0 group. PAI-1, D-dimer and INR level were negatively correlated, respectively(r were-0.263,-0.443; p were 0.010,0.000. respectively), while PAI-1 and D-dimer were positively correlated (r=0.468, P=0.000)6. During the study period, all the patients had no side effects such as stroke, Peripheral vascular thrombosis, gastrointestinal discomfort or bleeding.Conclusions:1. PAI-1 and D-dimer levels were markedly increased in NVAF patients, low fibrinolysis state is a important factor in the formation of hypercoagulable state in NVAF.2. PAI-1 and D-dimer were independent risk factors in the formation of hypercoagulable state in NVAF, we may predict thromboembolic events early by detecting plasm PAI-1 and D-dimer levels. 3. The risk factors of smoking, thromboembolism, diabetes mellitus and coronary heart disease may induce reduction of fibrinolysis by affecting PAI-1 and D-dimer levels in NVAF, thus promoting the hypercoagulant state and thrombosis in AF patients.4. Anticoagulant therapy can improve the fibrinolysis state in NVAF gradually, after 1 week treatment, the fibrinolysis state can be significantly improved. After 1 week treatment, PAI-1 levels in the AF group reduced to that in the control group; After 2 month treatment, D-dimer levels in the AF group reduced to that in the control group, anticoagulant therapy can improve the fibrinolysis state in NVAF patients quickly and effectively.5. With gradually increased anticoagulant treatment, the fibrinolysis state of AF could be impoved. Combining measurement of INR and PAI-1 or D-dimer, or both could assist us to monitor the hypercoagulant state in AF patients more comprehensively. |
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