1
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Kwon O, Ahn JH, Koh JS, Park Y, Hwang SJ, Tantry US, Gurbel PA, Hwang JY, Jeong YH. Platelet-fibrin clot strength and platelet reactivity predicting cardiovascular events after percutaneous coronary interventions. Eur Heart J 2024; 45:2217-2231. [PMID: 38804262 DOI: 10.1093/eurheartj/ehae296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND AIMS Platelet-fibrin clot strength (PFCS) is linked to major adverse cardiovascular event (MACE) risk. However, the association between PFCS and platelet reactivity and their prognostic implication remains uncertain in patients undergoing percutaneous coronary intervention (PCI). METHODS In PCI-treated patients (n = 2512) from registry data from January 2010 to November 2018 in South Korea, PFCS using thromboelastography and platelet reactivity using VerifyNow were measured. High PFCS (PFCSHigh) was defined as thromboelastography maximal amplitude ≥ 68 mm, and high platelet reactivity (HPR) was defined as >208 P2Y12 reaction units. Patients were stratified into four groups according to maximal amplitude and P2Y12 reaction unit levels: (i) normal platelet reactivity (NPR)-PFCSNormal (31.8%), (ii) HPR-PFCSNormal (29.0%), (iii) NPR-PFCSHigh (18.1%), and (iv) HPR-PFCSHigh (21.1%). Major adverse cardiovascular event (all-cause death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years. RESULTS High platelet reactivity and PFCSHigh showed an additive effect for clinical outcomes (log-rank test, P < .001). Individuals with NPR-PFCSNormal, NPR-PFCSHigh, HPR-PFCSNormal, and HPR-PFCSHigh demonstrated MACE incidences of 7.5%, 12.6%, 13.4%, and 19.3%, respectively. The HPR-PFCSHigh group showed significantly higher risks of MACE compared with the NPR-PFCSNormal group [adjusted hazard ratio (HRadj) 1.89; 95% confidence interval (CI) 1.23-2.91; P = .004] and the HPR-PFCSNormal group (HRadj 1.60; 95% CI 1.12-2.27; P = .009). Similar results were observed for all-cause death. Compared with HPR-PFCSNormal phenotype, NPR-PFCSNormal phenotype was associated with a higher risk of major bleeding (HRadj 3.12; 95% CI 1.30-7.69; P = .010). CONCLUSIONS In PCI patients, PFCS and platelet reactivity demonstrated important relationships in predicting clinical prognosis. Their combined assessment may enhance post-PCI risk stratification for personalized antithrombotic therapy.
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Affiliation(s)
- Osung Kwon
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79, Gangnam-ro, Jinju 52727, Republic of Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Seok Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79, Gangnam-ro, Jinju 52727, Republic of Korea
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79, Gangnam-ro, Jinju 52727, Republic of Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, 110, Deokan-ro, Gwangmyeong 14353, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, 84, Heukseok-ro, Seoul 06974, Republic of Korea
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2
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Yao Y, Li X, Wang Z, Xu S, Lv Q. The impact of high on-treatment platelet reactivity and fibrinogen levels on ischemic events in patients with ST elevation myocardial infarction: a prospective observational study. Int J Clin Pharm 2023; 45:461-472. [PMID: 36639521 DOI: 10.1007/s11096-022-01525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND After treatment, high residual platelet reactivity (HRPR) is considered as an essential risk factor for recurrent ischemic events. AIM To evaluate the impact of fibrinogen on HRPR after implantation of emergency drug-eluting stents (DES) in patients treated with aspirin and clopidogrel or ticagrelor due to ST-elevation myocardial infarction (STEMI) and to explore the predictive values of HRPR and fibrinogen for adverse ischemic events at 12 months. METHOD This single-center prospective observational study analyzed patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with second-generation DES implantation from January 2017 to December 2018. Platelet reactivity was measured by thromboelastography (TEG) at 60-72 h after primary PCI. HRPR was defined as the adenosine diphosphate-induced maximum amplitude (MAADP) > 47 mm. RESULTS A total of 919 patients were analyzed, of which 512 (55.8%) received aspirin and clopidogrel and 406 (44.2%) received aspirin and ticagrelor. Elevated fibrinogen levels were associated with an increased prevalence of HRPR (P < 0.001). High fibrinogen (quartile IV, ≥ 410 mg/dL) was an independent risk factor for HRPR after multivariate regression (odds ratio 6.556, 95% confidence interval [CI]: 3.200-13.431, P < 0.001). When analyzed by Kaplan-Meier survival curves, the combination of high fibrinogen and HRPR was strongly predictive for ischemic major adverse cardiac events at 12 months compared to the group without HRPR and with low fibrinogen (hazard ratio 9.681, 95% CI: 4.467-20.98, log-rank P < 0.001). Similar results were confirmed in subgroups according to different dual antiplatelet therapies. CONCLUSION A combination of high fibrinogen and HRPR may identify recurrent adverse ischemic events over 12 months. Ticagrelor exhibited more potent platelet inhibition and a better prognosis than clopidogrel.
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Affiliation(s)
- Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zi Wang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shikun Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
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3
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Onuoha CP, Ipe J, Simpson E, Liu Y, Skaar T, Kreutz RP. MicroRNA
sequencing in patients with coronary artery disease – considerations for use as biomarker for thrombotic risk. Clin Transl Sci 2022; 15:1946-1958. [PMID: 35643946 PMCID: PMC9372418 DOI: 10.1111/cts.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 12/05/2022] Open
Abstract
MicroRNAs (miRNAs) are small RNAs integral in the regulation of gene expression. Analysis of circulating miRNA levels may identify patients with coronary artery disease (CAD) at risk for recurrent myocardial infarction (MI) after percutaneous coronary interventions (PCIs). Subjects with CAD were selected from the GENCATH cardiac catheterization biobank. Subjects with recurrent MI after PCI were compared with those without recurrent MI during follow‐up in the initial (n = 48) and replication cohort (n = 67). Next generation MiRNA sequencing was performed on plasma samples and whole blood samples fixed with PAXGENE tubes upon collection. Overall, 164 miRNAs derived from whole blood were differentially expressed in the replication cohort between subjects with and without recurrent MI events (p < 0.05), with 69 remaining significant after false‐discovery rate (FDR) correction. None of the miRNAs in plasma was significantly different by FDR among subjects with and without MI. Overall, correlation between direction of effects between plasma and whole blood assays was variable, and only two miRNAs were concordant and significant in both. Associations of miRNA with vascular disease, MI, and thrombosis were further explored. MiRNA profiling has potential as the future biomarker for disease prognosis and treatment response marker in secondary treatment of patients with CAD after PCI. Whole blood may be the preferred sample source as compared to plasma.
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Affiliation(s)
- Chimnonso P. Onuoha
- Department of Medicine/Clinical Pharmacology Indiana University School of Medicine Indianapolis Indiana USA
| | - Joseph Ipe
- Department of Medicine/Clinical Pharmacology Indiana University School of Medicine Indianapolis Indiana USA
| | - Edward Simpson
- Center for Medical Genomics Indiana University School of Medicine Indianapolis Indiana USA
| | - Yunlong Liu
- Center for Medical Genomics Indiana University School of Medicine Indianapolis Indiana USA
| | - Todd C. Skaar
- Department of Medicine/Clinical Pharmacology Indiana University School of Medicine Indianapolis Indiana USA
| | - Rolf P. Kreutz
- Department of Medicine/Cardiology Indiana University School of Medicine Indianapolis Indiana USA
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4
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Yang L, Ruan L, Zhao Y, Lu Y, Shan Y, Zhang Y, Chen B, Zhang C, Li T. Association Between Thromboelastography and Coronary Heart Disease. Med Sci Monit 2022; 28:e935340. [PMID: 35490293 PMCID: PMC9069971 DOI: 10.12659/msm.935340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Thromboelastography (TEG) is a novel blood viscoelasticity detection method revealing blood coagulation status and has been reported to be helpful in predicting clinical outcomes in patients with cardiovascular diseases (CVD). In this study, we aimed to investigate the association between TEG and CVD. MATERIAL AND METHODS A single-center case-control study was performed. Individuals who took TEG tests at Tongji Hospital in Wuhan, China from 2015 to 2019 were included. The nearest-neighbor Mahalanobis matching with replacement, within propensity score calipers of 0.25 was used to control the covariate imbalance between CVD patients and controls. Logistic regression analyses were conducted to assess the relationship between TEG and CVD. Subgroup and sensitivity analyses were performed to evaluate the robustness of the association between TEG and CVD. RESULTS After matching, a total of 151 participants were included in this study, with 83 patients having CVD (49 patients having coronary heart disease [CHD] and 34 patients having an ischemic stroke). By comparison, CHD patients had a significantly higher maximum amplitude (MA) (P=0.02) than controls. After multivariable adjustment, MA (OR 1.11, 95% CI 1.01-1.24, P=0.04) was independently associated with CHD. The association between MA and CHD remained robust across subgroups and in sensitivity analyses. CONCLUSIONS The current study suggests that MA is significantly associated with CHD. Enhanced platelet reactivity as described by high MA might be associated with risk of CHD. The exact role of MA in the measurement of CHD risk needs to be further examined in large-scale prospective cohort studies.
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Affiliation(s)
- Liuqiao Yang
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, PR China
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
| | - Lei Ruan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yanping Zhao
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
- Shenzhen Key Laboratory of Unknown Pathogen Identification, BGI-Shenzhen, Shenzhen, Guangdong, PR China
| | - Yueqi Lu
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
| | - Ying Shan
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Bangwei Chen
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Tao Li
- BGI-Shenzhen, Shenzhen, Guangdong, PR China
- China National GeneBank, Shenzhen, Guangdong, PR China
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5
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Kietsiriroje N, Ariëns RAS, Ajjan RA. Fibrinolysis in Acute and Chronic Cardiovascular Disease. Semin Thromb Hemost 2021; 47:490-505. [PMID: 33878782 DOI: 10.1055/s-0040-1718923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis. In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired fibrin clot lysis in acute and chronic vascular conditions, including coronary artery, cerebrovascular, and peripheral vascular disease. We also discuss the role of combined anticoagulant and antiplatelet therapies to reduce the risk of arterial thrombotic events, addressing both efficacy and safety of such an approach. We conclude that impaired fibrin clot lysis appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic system represents a viable strategy to improve outcome in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic system and tailoring therapy according to the need of each individual.
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Affiliation(s)
- Noppadol Kietsiriroje
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.,Endocrinology and Metabolism Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Robert A S Ariëns
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ramzi A Ajjan
- Department of Metabolic Medicine, Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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6
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Zeinali R, del Valle LJ, Torras J, Puiggalí J. Recent Progress on Biodegradable Tissue Engineering Scaffolds Prepared by Thermally-Induced Phase Separation (TIPS). Int J Mol Sci 2021; 22:ijms22073504. [PMID: 33800709 PMCID: PMC8036748 DOI: 10.3390/ijms22073504] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/23/2022] Open
Abstract
Porous biodegradable scaffolds provide a physical substrate for cells allowing them to attach, proliferate and guide the formation of new tissues. A variety of techniques have been developed to fabricate tissue engineering (TE) scaffolds, among them the most relevant is the thermally-induced phase separation (TIPS). This technique has been widely used in recent years to fabricate three-dimensional (3D) TE scaffolds. Low production cost, simple experimental procedure and easy processability together with the capability to produce highly porous scaffolds with controllable architecture justify the popularity of TIPS. This paper provides a general overview of the TIPS methodology applied for the preparation of 3D porous TE scaffolds. The recent advances in the fabrication of porous scaffolds through this technique, in terms of technology and material selection, have been reviewed. In addition, how properties can be effectively modified to serve as ideal substrates for specific target cells has been specifically addressed. Additionally, examples are offered with respect to changes of TIPS procedure parameters, the combination of TIPS with other techniques and innovations in polymer or filler selection.
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Affiliation(s)
- Reza Zeinali
- Departament d’Enginyeria Química, Universitat Politècnica de Catalunya, Escola d’Enginyeria de Barcelona Est-EEBE, 08019 Barcelona, Spain; (L.J.d.V.); (J.T.)
- Correspondence: (R.Z.); (J.P.); Tel.: +34-93-401-1620 (R.Z.); +34-93-401-5649 (J.P.)
| | - Luis J. del Valle
- Departament d’Enginyeria Química, Universitat Politècnica de Catalunya, Escola d’Enginyeria de Barcelona Est-EEBE, 08019 Barcelona, Spain; (L.J.d.V.); (J.T.)
| | - Joan Torras
- Departament d’Enginyeria Química, Universitat Politècnica de Catalunya, Escola d’Enginyeria de Barcelona Est-EEBE, 08019 Barcelona, Spain; (L.J.d.V.); (J.T.)
| | - Jordi Puiggalí
- Departament d’Enginyeria Química, Universitat Politècnica de Catalunya, Escola d’Enginyeria de Barcelona Est-EEBE, 08019 Barcelona, Spain; (L.J.d.V.); (J.T.)
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, c/Baldiri Reixac 10-12, 08028 Barcelona, Spain
- Correspondence: (R.Z.); (J.P.); Tel.: +34-93-401-1620 (R.Z.); +34-93-401-5649 (J.P.)
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7
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Sumaya W, Wallentin L, James SK, Siegbahn A, Gabrysch K, Bertilsson M, Himmelmann A, Ajjan RA, Storey RF. Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy. Eur Heart J 2019; 39:1078-1085. [PMID: 29390064 PMCID: PMC6019045 DOI: 10.1093/eurheartj/ehy013] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022] Open
Abstract
Aims To determine whether fibrin clot properties are associated with clinical outcomes following acute coronary syndrome (ACS). Methods and results Plasma samples were collected at hospital discharge from 4354 ACS patients randomized to clopidogrel or ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. A validated turbidimetric assay was employed to study plasma clot lysis time and maximum turbidity (a measure of clot density). One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were estimated using Cox proportional hazards models. After adjusting for CV risk factors, each 50% increase in lysis time was associated with CV death/spontaneous MI [HR 1.17, 95% confidence interval (CI) 1.05-1.31; P < 0.01] and CV death alone (HR 1.36, 95% CI 1.17-1.59; P < 0.001). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death (HR 1.24, 95% CI 1.03-1.50; P = 0.024). After adjustment for other prognostic biomarkers (leukocyte count, high-sensitivity C-reactive protein, high-sensitivity troponin T, cystatin C, N-terminal pro B-type natriuretic peptide, and growth differentiation factor-15), the association with CV death remained significant for lysis time (HR 1.2, 95% CI 1.01-1.42; P = 0.042) but not for maximum turbidity. These associations were consistent regardless of randomized antiplatelet treatment (all interaction P > 0.05). Neither lysis time nor maximum turbidity was associated with major bleeding events. Conclusion Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients. Novel therapies targeting fibrin clot properties might be a new avenue for improving prognosis in patients with ACS.
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Affiliation(s)
- Wael Sumaya
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 38, SE-752 37 Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 38, SE-752 37 Uppsala, Sweden
| | - Agneta Siegbahn
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 38, SE-752 37 Uppsala, Sweden.,Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Katja Gabrysch
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 38, SE-752 37 Uppsala, Sweden
| | - Maria Bertilsson
- Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 38, SE-752 37 Uppsala, Sweden
| | | | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
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8
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Shi H, Shi B, Lu J, Wu L, Sun G. Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient. Exp Ther Med 2019; 17:3483-3488. [PMID: 30988727 PMCID: PMC6447791 DOI: 10.3892/etm.2019.7333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/20/2019] [Indexed: 11/21/2022] Open
Abstract
Application value of thromboelastography (TEG) in perioperative clinical blood transfusion and its effect on the outcome of patient were investigated. Seventy-four patients, admitted to The Surgical Department of the First Hospital of Zibo from March 2015 to March 2018, were selected for this study. Among them, 34 patients took only the traditional coagulation function testing method as the blood transfusion guide during the perioperative period and they were regarded as the control group. The other 40 patients used TEG as the blood transfusion guide during the perioperative period, and they were regarded as the TEG group. The coagulation function indicators in 2 h before the operation and in 24 h after the operation, the transfusion amount and blood loss during the operation, the condition of the blood transfusion during the perioperative period, the occurrence rate of the postoperative rebleeding, the length of hospital stay and mortality of the patients in the two groups were compared. The coagulation function indicators of the patients in the two groups in 2 h before the operation and in 24 h after the operation showed that there was no significant difference between the two groups (P>0.050). However, APTT and Pt of the patients in the two groups both increased when compared with those before the treatment (P<0.050) and Hb, Hct, Plt and Fib all decreased (P<0.050). The suspended erythrocytes, Plt, fibrinogen and plasma in the TEG group were both significantly lower than those in the control group (P<0.001). Compared with the traditional coagulation function test, TEG was more accurate for estimating the coagulation function of patient and was more suitable for estimating the condition of blood transfusion of patient in the perioperative period; also, it could shorten the recovery period of patient and it is worthwhile to promote it in the clinic.
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Affiliation(s)
- Haiyan Shi
- Department of Blood Transfusion, The First Hospital of Zibo, Zibo, Shandong 255000, P.R. China
| | - Bo Shi
- Department of Neurology, The First Hospital of Zibo, Zibo, Shandong 255000, P.R. China
| | - Jun Lu
- Department of Blood Transfusion, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Lingling Wu
- Department of Blood Transfusion, Quanzhou First Hospital Affiliated to Medical University of Fujian, Quanzhou, Fujian 362000, P.R. China
| | - Guang Sun
- Department of Intensive Care Unit, Central Hospital of Zibo, Zibo, Shandong 255000, P.R. China
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9
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Abstract
Circulating levels of Brain Derived Neurotrophic Factor (BDNF) are lower in coronary heart disease (CHD) than in healthy subjects and are associated with coronary events and mortality. However, the mechanism(s) underling this association is not fully understood. We hypothesize that BDNF may influence fibrin fiber structure and clot stability, favoring clot lysis and thrombus resolution. We showed that recombinant BDNF (rh-BDNF) influenced with clot formation in a concentration-dependent manner in both purified fibrinogen and plasma from healthy subjects. In particular, rh-BDNF reduced the density of fibrin fibers, the maximum clot firmness (MCF) and the maximum clot turbidity, and affected the lysis of clot. In addition, both thrombin and reptilase clotting time were prolonged by rh-BDNF, despite the amount of thrombin formed was greater. Intriguingly, CHD patients had lower levels of BDNF, greater fibrin fibers density, higher MCF than control subjects, and a negative correlation between BDNF and MCF was found. Of note, rh-BDNF markedly modified fibrin clot profile restoring physiological clot morphology in CHD plasma. In conclusion, we provide evidence that low levels of BDNF correlate with the formation of bigger thrombi (in vitro) and that this effect is mediated, at least partially, by the alteration of fibrin fibers formation.
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10
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Facile preparation of a controlled-release tubular scaffold for blood vessel implantation. J Colloid Interface Sci 2018; 539:351-360. [PMID: 30594010 DOI: 10.1016/j.jcis.2018.12.086] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/16/2018] [Accepted: 12/22/2018] [Indexed: 01/08/2023]
Abstract
Salvianic acid-loaded mesoporous silica nanoparticles into gelatin/polyurethane bilayered small-diameter tubular scaffold were prepared by thermally induced phase separation (TIPS) and electrospinning. Mesoporous silica nanoparticles (MSNs) were selected as carriers to load salvianic acid (SAL). The SAL-loaded MSNs (SAL@MSNs) with an optimized SAL loading efficiency of 10% was initially dispersed in gelatin solution and under a vacuum freeze-drying process as an inner layer of vascular scaffolds. Then, poly(ester-urethane)urea (C-PEEUU) nanofibers were electrospun outside the SAL@MSNs/Gelatin vascular scaffold to strengthen the spongy matrix. The loaded SAL within the MSNs/Gelatin/C-PEEUU bilayered small-diameter tubular scaffold showed a sustained release profile and good mechanical properties. In addition, the drug-loaded composite scaffold showed no unfavorable effects on the adhesion and proliferation of endothelial cells. Moreover, no intimal hyperplasia and acute thrombosis was observed in the short-term implantation in rabbit's carotid artery. We believe the SAL@MSNs/Gelatin/C-PEEUU bilayered vascular scaffolds have promise for vascular tissue engineering applications.
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11
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Kreutz RP, Schmeisser G, Schaffter A, Kanuri S, Owens J, Maatman B, Sinha A, von der Lohe E, Breall JA. Prediction of Ischemic Events after Percutaneous Coronary Intervention: Thrombelastography Profiles and Factor XIIIa Activity. TH OPEN 2018; 2:e173-e181. [PMID: 30882064 PMCID: PMC6419750 DOI: 10.1055/s-0038-1645876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background
High plasma fibrin clot strength (MA) measured by thrombelastography (TEG) is associated with increased risk of cardiac events after percutaneous coronary interventions (PCIs). Factor XIIIa (FXIIIa) cross-links soluble fibrin, shortens clot formation time (TEG-K), and increases final clot strength (MA).
Methods
We analyzed platelet-poor plasma from patients with previous PCI. Kaolin-activated TEG (R, K, MA) in citrate platelet-poor plasma and FXIIIa were measured (
n
= 257). Combined primary endpoint was defined as recurrent myocardial infarction (MI) or cardiovascular death (CVD). Relationship of FXIIIa and TEG measurements on cardiac risk was explored.
Results
FXIIIa correlated with TEG-MA (
p
= 0.002) and inversely with TEG-K (
p
< 0.001). High MA (≥35.35 mm;
p
= 0.001), low K (<1.15 min;
p
= 0.038), and elevated FXIIIa (≥83.51%;
p
= 0.011) were associated with increased risk of CVD or MI. Inclusion of FXIIIa activity and low TEG-K in risk scores did not improve risk prediction as compared with high TEG-MA alone.
Conclusion
FXIIIa is associated with higher plasma TEG-MA and low TEG-K. High FXIIIa activity is associated with a modest increase in cardiovascular risk after PCI, but is less sensitive and specific than TEG-MA. Addition of FXIIIa does not provide additional risk stratification beyond risk associated with high fibrin clot strength phenotype measured by TEG.
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Affiliation(s)
- Rolf P Kreutz
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States.,Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Glen Schmeisser
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Andrea Schaffter
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Sri Kanuri
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Janelle Owens
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States.,Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Benjamin Maatman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Anjan Sinha
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Elisabeth von der Lohe
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Jeffrey A Breall
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, United States
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12
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Maatman BT, Schmeisser G, Kreutz RP. Fibrin Clot Strength in Patients with Diabetes Mellitus Measured by Thrombelastography. J Diabetes Res 2018; 2018:4543065. [PMID: 29507861 PMCID: PMC5817329 DOI: 10.1155/2018/4543065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) exhibit increased risk of recurrent myocardial infarction. Maximal clot strength measured by thrombelastography (TEG) is a risk factor for recurrent ischemic events. We hypothesized that diabetic subjects exhibit increased fibrin clot strength in platelet-poor plasma and that glycemic control correlates with maximal fibrin clot strength. METHODS We collected plasma samples from subjects with known or suspected coronary artery disease undergoing cardiac catheterization (n = 354). We measured kaolin-activated TEG in platelet-poor citrate plasma. Time to fibrin formation (R), clot formation time (K), and maximal fibrin clot strength (MA) were recorded. RESULTS Plasma fibrin MA was increased among subjects with DM (n = 152) as compared to non-DM (n = 202) (37.0 ± 8 versus 34.1 ± 8 mm; p < 0.001). Hemoglobin A1c (HbA1c) (ρ = 0.22; p = 0.001) and fibrinogen (ρ = 0.29; p < 0.001) correlated with fibrin MA. In multivariable regression analysis, DM remained significantly associated with plasma MA after adjustment for fibrinogen level (p = 0.003). CONCLUSIONS Subjects with diabetes mellitus exhibit increased maximal fibrin clot strength measured by TEG in platelet-poor plasma.
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Affiliation(s)
- Benjamin T. Maatman
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen Schmeisser
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rolf P. Kreutz
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
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