| In patients with chronic atrial fibrillation (AF), the direct reason of thromboembolism is the formation and migration of thrombus in left atrium (LA) and/or left atrial appendage (LAA) . It is important to study the prothrombotic state and thrombosis to prevent thromboembolism in patients with atrial fibrillation. Anticoagulation therapy with warfarin is able to reduce the thromboembolism incident. Recet studies shows that AF itself is responsible for promoting the prothrombotic state and thrombosis which is presented by the variation of b100d parameters. Warfarin prevents new thrombus formation; moreover, the existing thrombi resolution has been observed by transesophageal echocardiography (TEE). The measurement of b100d parameters on coagulative-anticoagulative activity and fibrinolytic activity can not only estimate the coagulablestate in AP patients, but evaluate the effects of warfarin treatmeat. At present time, the relation of anticoagulative-fibrinolytic activity to thrombosis in chronic atrial fibrillation patients and the effects of warfarin treatments have not been demonstrated completely. The data about those questions is poor.In this study, we measured the b100d parameters before and after warfarin therapy for 4 weeks. Furthermore we investigated LA/LAA thrombus by performing TEE in order to explore: (1) the variation of coagulative-anticoagulative activity and thrombosis in chronic atrial fibrillation patients, (2) the effects of warfarin treatment, (3) means to evaluate the benefit of anticoagulation therapy with warfarin.Patients and methods: sixty-two patients with AF were divided into two groups according to the result of TEE examination, including 15 patients with LA/LAA thrombus (thrombus group) and 47 patients without thrombus (non-thrombus group). On the basis of medical ethics, all patients in thrombus group were administered warfarin (5mg/d). The patients without thrombus were randomized into warfarin group (n=24) and no-warfarin group(n=23).Clinical conditions were similar in each group. B100d parameters which obtained before and after warfarin treatment were compared by self-comparison design. TEE was repeated for patients with LA/LAA thrombus. In addition, the control group was composed of twentyhealthy subjects with sinus rhythm who matched for age and gender. The b100d parameters were: antithrombin-III (AT-III) and tissue plasminogen activator (tPA) activity determined by spectrophoto-metric assay; D-dimer (DD) concentration measured by enzyme-linked immunosorbent assay (ELISA).Result: (1) LA/LAA thrombosus was identified By TEE in 15 cases (17 clots) of 62 AF patients, including 5 cases (5 clots) in LA, 9 cases (10 clots) in LAA and 1 cases (2 clots) in both LA and LAA. The size of thrombi ranged from 7mm X 6mm to 65mm X 27mm.The shape of clots was mainly irregular ball; also there were clots extended from LAA mouth to LAA body along the atrial wall. After warfarin therapy, 11 cases (11 clots) were disappeared, including 5 cases (5 clots) in LA and 6 cases (6 clots) in LAA. The maximum diameter of disappeared thrombus was 33mm X 19mm. However, 4 cases (6 clots), which including 3 cases (4 clots)in LAA and 1 case (2 clots) in both LA and LAA, did not change significantly. (2) To compared AF patients with healthy sinus subjects, AT-III activity reduced from 92.92+17.46% to 66.89 + 22.74% (p<0.05) and tPA activity reduced from 0.43 + 0.13 IU/ml to 0.25 + 0.09 lU/ml (po.05), however, DD concentration elevated from 330.60 + 118.44 ng/ml to 542.23 + 136.83 ng/ml (po.05). (3) To make further compare thrombus group in AF patients with non-thrombus group in AFpatients, AT-III activity decreased from 66.89 + 22.74% to 47.89 + 15.10%) O<0.05) and tPA activity decresed from 0.25 + 0.09 lU/ml to 0.17 + 0.08 lU/ml (po.05), but DD concentration incresed from 542.23+ 136.83ng/ml to 674.33 + 108.23 ng/ml (po.05). (4) Before and after warfarin treatment in the AF patients with thrombus, AT-III activity, tPA activity and DD concentration were 47.89+15.10% vs 91.65 + 23.04%)(po...
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