| Backgroud: Atrial fibrillation (AF), the common arrhythmia, is liable to thrombosis and is a risk factor of embolic events of stroke and peripheral embolism. It has been being an crucial problem in the research field of AF to select the high-risk embolism group from patients with AF and to make reasonable anticoagulant therapy to decrease complications of cerebral embolism and hemorrhage. AF can result in the prothrombotic state, especially, the activation of coagulation system. Clotting cascade finally leads to the formation of thrombin, so the thrombin is the key step to form the thrombus. Moreover, because the anticoagulant treatments are mainly aimed at the inhibition of the thrombin, to study the alteration of plasma thrombin-antithrombin III (TAT) levels, which can indicate the more formation of thrombin and the increase of the activity of it, it will provide theoretical basis for taking effective measures to estimate embolic risk of patients with AF, to select the high-risk embolic group, to make reasonable anticoagulant therapy and to decrease embolic complications.Objective: In this study, we measured the alteration of some plasma coagulation system molecular makers and studied the influence of the anticoagulant or anti-platelet drugs on them in order to explore (1) the alteration of TAT concentration and the value of it in evaluating embolic risk in patients with AF (2) the influence of the oral anticoagulant and anti-platelet drugs on TAT and clinical value of it.Patients and Methods: 89 patients with AF, 54 males, 35 females, aged from 21 to 85 years (62.54+12.68 years). In them, 27 patients underwent thetransesophageal echocardiography (TEE), the thrombi were found in 10 patients. The thrombus group (n=18) included this 10 patients and other 8 patients who suffered from the complications of peripheral embolism. The non-thrombus group included 17 patients who had no thrombus in left atrium(LA)/left atrial appendage(LAA) according to the detection of TEE. Another 54 patients with AF without TEE detection and thromboembolism complication were the AF group. The non-AF group included 33 patients with sinus rhythm. The warfarin group included 14 patients who received the dose-adjustment warfarin treatment in all AF patients with thrombus or complication of embolism or mid and high-risk of embolism. In the patients without warfarin, 21 patients who received the aspirin treatments (100 mg/d) were aspirin group, the others without aspirin treatment were the control group(n=20). The blood parameters were: TAT ,D-dimer(D-D) levels determined by enzymelinked immunosorbent assay (ELISA) and antithrombin-III(AT- III ) activity by spectrophotometric assay. Patients in the warfarin group whose the international ratio were equal to or more than 1.5 and kept stable for 3 days and patients in aspirin group with one week of aspirin treatment, were reexamined about the levels of the TAT. The INR and TAT were measured at the same time in the patients (n=26) when their INR were reached to or exceeded 1.5.ResuIts:(l)LA/LAA thrombus was identified by TEE in10 cases(12 clots) in 27 AF patients, including 8 cases (10 clots) in LAA and 2 cases(2 clots) in LA, The size of thrombi ranged from 8X7mm to 38 X 30mm. The shapes of clots were mainly irregular ball, 8 cases suffered from thromboembolism complication, including cerebral embolism confirmed by computed tomography of brain and peripheral embolism confirmed by echocardiography. (2) To compare AF patients with sinus group, TAT, D-D concentration elevated from 4.22 1.46ug/L to 4.94 1.70ug/L (P<0.05), from0.36 0.11 ng/ml to 0.43 0.15ng/ml, respetively. AT-III activity decreased from 101.44 16.39 to 94.93 12.06%(P<0.05), to make further compare thrombus group with non-thrombus group, TAT, D-D concentration elevated from 5.05 2.01ug/L to 6.56 2.31ug/L(P<0.05), from 0.39 0.25 to 0.62 0.24 ug/L,respectively. AT-â…¢ activity decreased from 96.64 16.63 to 94.45 16.77 %(P>0.05). (3) When INR kept stable for 3 days in AF patients with warfarin treatment, the concentration,...
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