The endothelium and atrial fibrillation

B. Freestone; G. Y. H. Lip

doi:10.1055/s-0037-1617102

Hämostaseologie, Table of Contents

Hamostaseologie 2008; 28(04): 207-212
DOI: 10.1055/s-0037-1617102

Original Article

Schattauer GmbH

The endothelium and atrial fibrillation

The prothrombotic state revisitedEndothel und VorhofflimmernProthrombotische Zustände neu betrachtet

Authors

B. Freestone

Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom
G. Y. H. Lip

Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom

Abstract

Zusammenfassung

Vorhofflimmern (VHF), die häufigste anhaltende Herzrhythmusstörung, ist mit hohem Mortalitäts- und Morbiditätsrisiko verbunden. Es kann Schlaganfall und Thromboembolie verursachen. Mechanismen, die bei VHF Thromboembolie und nachfolgend zerebrovaskuläre Ereignisse auslösen, werden intensiv erforscht und müssen genau geklärt werden. VHF erfüllt zweifellos die Virchow-Trias der Thrombogenese: gestörte Blutzirkulation mit Verlust der Kontraktilität der Vorhöfe und absolute Kammerarrhythmie (d. h. gestörter Blutfluss), strukturelle Herzerkrankung mit Endothelschädigung (d. h. Gefäßwandläsionen), Abnormitäten bei Thrombozyten und hämostatischen Variablen (d. h. pathologische Blutbestandteile).

In dieser Übersicht werden die aktuellen Erkenntnisse zur Rolle der Blutgerinnung und fibrinolytischen Komponenten, Thrombozyten und Entzündungszellen (Blutzusammensetzung) zusammengefasst, die zu prothrombotischen Zuständen bei VHF führen. Dabei werden Endothel und VHF besonders berücksichtigt.

Summary

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, which confers a high risk of mortality and morbidity from stroke and thromboembolism. The precise mechanisms by which AF causes thromboembolism and subsequent cerebrovascular events have attracted much research interest, and are yet to be fully elucidated. Nonetheless, it is well recognised that AF fulfils Virchow’s triad for thrombogenesis, with abnormal flow conditions with loss of atrial contractility and an irregularly irregular cardiac output, (i. e. flow abnormalities), as well as structural heart disease with endocardial damage (i. e. abnormal vessel wall) and abnormalities in platelet and haemostatic variables (i. e. abnormal blood constituents).

This review is to summarise the evidence so far for the role of coagulation and fibrinolytic components, platelets and inflammation (that is blood constituents) in the generation of the prothrombotic state in AF, with particular focus on the endothelium and AF.

Schlüsselwörter

Vorhofflimmern - prothrombotischer Zustand - Endothelschädigung - Endotheldysfunktion

Keywords

Atrial fibrillation - prothrombotic state - endothelial damage - endothelial dysfunction

Full Text

References

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