Paroxysmal atrial fibrillation: changes in factor VIII and von Willebrand factor impose early hypercoagulability

Mariya Negrinova Negreva; Krasimira Prodanova; Katerina Vitlianova; Christiana Madjova

doi:10.5114/amsad.2020.97101

Paroxysmal atrial fibrillation: changes in factor VIII and von Willebrand factor impose early hypercoagulability

Arch Med Sci Atheroscler Dis. 2020 Jul 11:5:e140-e147. doi: 10.5114/amsad.2020.97101. eCollection 2020.

Authors

Mariya Negrinova Negreva¹, Krasimira Prodanova², Katerina Vitlianova³, Christiana Madjova⁴

Affiliations

¹ Department of Cardiology, Faculty of Medicine, Medical University "Prof. Dr. P. Stoyanov", Varna, Bulgaria.
² Faculty of Applied Mathematics and Computer Science, Technical University of Sofia, Sofia, Bulgaria.
³ Clinic of Cardiology, Second City Hospital of Sofia, Sofia, Bulgaria.
⁴ Department of Conservative Dentistry and Oral Pathology, Faculty of Dental Medicine, Medical University, Varna, Bulgaria.

Abstract

Introduction: Paroxysmal atrial fibrillation (PAF) is a well-documented prothrombotic state that carries significant embolic risk. However, precise hemostatic changes in the very early stage of the disease are not completely studied. The aim of the study was to study von Willebrand factor (vWF) and coagulation factor VIII (FVIII) plasma levels and activity in the first hours (up to 24 h) of PAF clinical manifestation.

Material and methods: We selected consecutively 51 non-anticoagulated patients (26 men, 25 women, mean age: 59.84 ±1.60) with PAF and 52 controls (26 men, 26 women, mean age: 59.50 ±1.46 years) corresponding in gender, accompanying diseases and conducted treatment. The indicators were examined using enzyme-linked immunoassays and photometric tests.

Results: All patients were hospitalized between the 2^nd and 24^th h after the onset of arrhythmia (mean: 8.14 ±0.74 h). Higher FVIII levels (107.52 ±3.48% vs. 93.85 ±2.93%, p < 0.05) and activity (200.03 ±11.11% vs. 109.73 ±4.90%, p < 0.001) were found in the PAF group. vWF levels (178.40 ±12.95% vs. 119.53 ±6.12%, p < 0.001) and activity (200.92 ±12.45% vs. 110.80 ±5.14%, p < 0.001) were also higher. These changes did not depend on age, sex, body mass index or CHA₂DS₂-VASc score in the PAF group (p > 0.05). PAF duration was a significant predictor of increased FVIII levels and activity. Increased PAF duration was followed by increased values of the factors (r = 0.85, p < 0.001; r = 0.83, p < 0.001).

Conclusions: The results presented an activated coagulation cascade and endothelial injury, suggesting hypercoagulability still in the early hours of PAF. These changes in PAF did not correlate with CHA₂DS₂-VASc score risk factors, outlining PAF as a possible independent embolic risk factor.

Keywords: coagulation cascade; endothelial injury; paroxysmal atrial fibrillation.