ABSTRACT
Background: Atrial fibrillation is associated to a high risk of systemic embolism and to hypercoagulability. Aim: To evaluate the activation of the coagulation cascade through determinations of the thrombin-antithrombin complex in patients with atrial fibrillation and to correlate this data with the clinical and echocardiographic risk factors for systemic embolism. Patients and Methods: In 53 patients with atrial fibrillation plasma levels of the thrombin-antithrombin complex were determined on admission to a coronary care unit and 30 days later. Using a univariate and multiple regression analysis, the association basal thrombin-antithrombin with the duration of the arrhythmia, age over 70 years, previous use of antiplatelet agents, history of hypertension, mitral valve disease, diabetes, heart failure, previous systemic embolism, left atrial diameter and the presence of spontaneous contrast echo or thrombus in the left atrial appendage, was studied. Results: Basal thrombin-antithrombin values were 40.1ñ69 mg/L (Median 8.34 [3.0-47.5]) compared to 2.7ñ3.3 mg/L in healthy controls (p <0.001). No significant correlation was found between activation of the coagulation cascade and risk factors for systemic embolism. There were no significant differences in thrombin-antithrombin values between patients with chronic or paroxysmal atrial fibrillation (29.5ñ43 mg/L and 49.4ñ83 mg/L respectively). Mean thrombin-antithrombin values in patients under antiplatelet agents were lower than in those without treatment (17.3ñ43 vs 66.8ñ127 mg/L; p=0.018). Conclusions: The activation of the coagulation cascade in patients with atrial fibrillation was confirmed. However, no association of this activation with well known clinical and echocardiographic risk factors for systemic embolism, was found. Previous antiplatelet treatment prevented a higher activation of the coagulation cascade
Subject(s)
Humans , Male , Female , Thrombophilia , Atrial Fibrillation/complications , Thromboembolism , Echocardiography , Case-Control Studies , Risk Factors , Hemostasis , Platelet Aggregation Inhibitors/therapeutic use , Coagulation Protein Disorders/diagnosisABSTRACT
Background: Paroxysmal atrial fibrillation may predispose to systemic embolism. There is little information about the evolution of cardiac rhythm and the occurrence of new embolic events in these patients. Aim: To report the results of a long term follow up of patients with paroxysmal atrial fibrillation. Patients and methods: Patients consulting for non valvular paroxysmal atrial fibrillation were followed for a mean period of 5 years. An EKG, 2D echocardiogram and brain CT scans were performed on admission and at the end of the follow up period to all patients. Results: Sixty eight patients aged 65 ñ 1.5 years were studied. Thirty two had an idiopathic atrial fibrillation, 28 had a history of mild hypertension and 8 had a history of coronary artery disease. Evidence of systemic emboli was found in 17 patients at entry (to the brain in 14 patients). During the follow up 87 per cent of patients required antiarrhythmics, 27 per cent were anticoagulated and 28 per cent received aspirin. Five patients had new embolic episodes. Of these, four had a history of prior embolism. Forty one percent of patients continued in sinus rhythm and remained asymptomatic, 32 per cent had at least one recurrence of paroxysmal atrial fibrillation and nine patients evolved to chronic atrial fibrillation. Five patients required a permanent pacemaker due to symptomatic bradycardia. Conclusions: Most patients with non valvular paroxysmal atrial fibrillation remain in sinus rhythm but one third have recurrences of the arrhythmia. A main risk factor for embolism is the history of previous embolic episodes
Subject(s)
Humans , Male , Female , Atrial Fibrillation/physiopathology , Arrhythmias, Cardiac/diagnosis , Embolism/etiology , Anticoagulants/therapeutic use , Atrial Fibrillation/complicationsABSTRACT
We report 3 women aged 33, 63 and 43 years old receiving an anorexigenic medication that contained phenylpropanolamine who 30 min to 3 h after the ingestion of this medication, presented a frontal hematoma, a left putaminal hematoma and a subaracnoidal hemorrhage, respectively. Cerebral angiography, performed in all of them, did not show any vascular abnormality. This complication of phenylpropanolamine use has been reported previously abroad and the mechanism of production, could be related to an elevation of blood pressure and the production of a vasculitis by the drug. The risk of this complication must be taken into account when prescribing phenylpropanolamine
Subject(s)
Humans , Female , Adult , Middle Aged , Phenylpropanolamine/adverse effects , Cerebral Hemorrhage/chemically induced , Hypertension/complications , Hypertension/etiologySubject(s)
Humans , Brain Diseases, Metabolic/complications , Hypertension/complications , Cerebral Hemorrhage/diagnosis , Cerebral Infarction/diagnosis , Dementia, Multi-Infarct/diagnosis , Hypertension/complications , Intracranial Embolism and Thrombosis/diagnosis , Ischemic Attack, Transient/physiopathologySubject(s)
Humans , Male , Female , Intracranial Arteriosclerosis , Cerebral Arteries/injuries , Cerebrovascular CirculationABSTRACT
Las infecciones oportunistas del SNC han aumentado en los últimos años. Este tipo de complicación ha ampliado el espectro clínico neurológico, es de defícil diagnóstico y conlleva una alta mortalidad. Con el fin de analizar nuestra realidad se revisaron 5.612 autopsias practicadas en los últimos 26 años en dos hospitales. Se encontraron 151 necropsias con infecciones oportunistas. El SNC ocupa el 4§ lugar con 6 casos de Candidiasis, 6 de Aspergilosis, 4 de Zigomicosis, 3 de Criptococosis, 1 de Nocardiosis, 1 de Citomegalovirosis y 5 de Herpes virosis. La distribución, frecuencia y condiciones clínicas de nuestras infecciones oportunistas fue semejante a lo publicado en series extranjeras