Thromb Haemost 2011; 105(03): 435-443
DOI: 10.1160/TH10-09-0615
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Levels of von Willebrand factor and ADAMTS13 determine clinical outcome after cardioversion for atrial fibrillation

Matthias K. Freynhofer
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Veronika Bruno
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Rudolf Jarai
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Susanne Gruber
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Thomas Höchtl
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Ivan Brozovic
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Serdar Farhan
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Johann Wojta
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
,
Kurt Huber
1   3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Received: 27 September 2010

Accepted after major revision: 25 November 2010

Publication Date:
27 November 2017 (online)

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Summary

Von Willebrand factor (vWF) plays an essential role in platelet adhesion and thrombus formation. Patients with atrial fibrillation (AF) exhibit higher plasma vWF and lower ADAMTS13 antigen levels compared to controls. Little is known about vWF and ADAMTS13 in AF patients treated with cardioversion (CV). Thus we investigated the alterations of plasma vWF and ADAMTS13 after CV and evaluated the predictive value of these parameters for recurrence of AF. In this observational study we determined plasma levels of vWF and ADAMTS13 in 77 patients before and immediately after CV, as well as 24 hours (h) and six weeks thereafter, by means of commercially available assays. The vWF/ ADAMTS13-ratio was significantly elevated immediately after CV (p=0.02) and 24 h after CV (p=0.002) as compared to baseline levels. ADAMTS13, 24 h after CV, exhibited a significant association with recurrence of AF (HR: 0.97; p=0.037). Accordingly, tertiles of ADAMTS13 showed a stepwise inverse correlation with the risk of recurrent AF (HR: 0.50; p=0.009). After adjustment for confounders, ADAMTS13 remained significant as an independent predictor of recurrent AF (HR: 0.61; p=0.047). Similarly, the vWF/ADAMTS13-ratio, 24 h after CV, was associated with rhythm stability and remained an independent predictor of recurrent AF (HR: 1.88; p=0.028). The regulation of vWF and its cleaving protease ADAMTS13 after CV might play a critical role in producing a pro-thrombotic milieu immediately after CV for AF. Since ADAMTS13 plasma concentration and the vWF/ADAMTS13-ratio are independently associated with rhythm stability, these indexes might be used for prediction of recurrence of AF.