| Background Atrial fibrillation (AF), the most common sustained cardial arrhythmia,is a major cause of morbidity and mortality through an increased risk of thyomboembolic complications (including stroke and peripheral embolism). Thyomboembolic complications are mostly correlated with the prothrombotic state (PTS). PTS is caused by coactivation of endothelial cells, platelet, coagulative activity, fibrinolytic activity and blood flow. Endothelial dysfunction and platelet activity initiate this process, while anticoagulative activity and fibrinolytic system sustain it, at last forming thrombus. Such thrombi are used to being found in left atrius or/and left atrial appendage and are the direct reason for thyomboembolic complications of atrial fibrillation.Study of embolic events used to focus on the function of coagulative system. Using warfarin to prevent such events received good results. Now warfarin has been a formal anticoagulative treatment of AF. But warfrain's potential side effect of severe bleeding and the need of frequency measurement made it restrict. Nowadays, more and more studies concentrate on platelet activity and endothelial dysfunction. People try to find a new way to prevent embolism events through antiplatelet drugs and improving endothelial functions, especially encouraged by the new antiplatelet drug-platelet GP II b/IIIa inhibitor which received well effect on coronary heartdieases.Objectives In this study, we measured the alterative levels of plasma solubleP-selectin (an index of platelet activation), von Willebrand factor (a marker of endothelial function), D-dimer (a marker of fibrinolytic activity) and MPV. Meanwhile we investigated LA/LAA thrombi by TEE or thromboembolic complications in order to explore the value of the plasma markers in evaluating the risk of embolic events.Patients and Methods 89 patients with AF, 54 males and 35 females, age from21 to 85(62.54+12.68). 27 patients underwent the TEE. The blood parameters were (1) plasma soluble P-selectin (2) von Willebrand factor (3)D-dimer, measured by enzymelinked immunosorbent assay(ELISA) (4) mean platelet volume, measured by automatic hematologic analyzer.Results (1) We found 12 thrombi in LA or/and LAA with TEE, including 10 inLAA and 2 in LA. Thrombi size changed from 8X7 mm to 38 X 30mm, 8 patients had embolic complications:5 cerebral embolic confirmed by computed tomography of brain and 3 peripheral embolic confirmed by UCG. (2) To compare AF patients with sinus subjects, plasma soluble P-selectin level increased from 10.85+1.96 to 11.97 + 2.49ng/ml, vWF activity increased from 134.39+47.56 to 155.82+46.12, D-dimer concentration from 0.36 + 0.11 to 0.43 + 0.15ug/ml, MPV level from 8.59+1.13 to 9.23 +1.43fl(P<0.05). To further compare thrombus group with no-thrombus group, plasma soluble P-selectin level increased from 11.47+2.84 to 14.96 + 3.68ng/ml, D-dimer concentration increased from 0.39 + 0.25 to 0.62 + 0.24ug/ml, MPV level from 9.06+1.17 to 10.13 +1.18fl(P<0.05), while vWF activity increased from 159.95+41.55 to 142.20+48.02(P>0.05).(3) Plasma soluble P-selectin is positive correlate with D-dimer in thrombus group.Conclusion (1) There is a prothrombotic state in patients with AF which aredemonstrated by increasing soluble P-selectin, MPV, vWF level and D-dimer concentration. (2) Plasma soluble P-selectin level, D-dimer concentration and MPVlevel significantly increase in AF with LA/LAA thrombus and embolic complications. (3) Plasma soluble P-selectin level in thrombus group positively correlates with D-dimer concentration .So it may be a valuable marker to evaluate thromboemobic complications of atrial fibrillation.
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