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Bararu Bojan I, Dobreanu S, Vladeanu MC, Ciocoiu M, Badescu C, Plesoianu C, Filip N, Iliescu D, Frasinariu O, Bojan A, Tudor R, Badulescu OV. The Etiology of the Thrombotic Phenomena Involved in the Process of Coronary Artery Disease-What Is the Role of Thrombophilic Genes in the Development of This Pathology? Int J Mol Sci 2024; 25:5228. [PMID: 38791267 PMCID: PMC11120830 DOI: 10.3390/ijms25105228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Cardiovascular diseases, among which includes coronary artery disease, represent one of the most important causes of mortality and morbidity worldwide. Research aimed at determining the risk factors involved recognizes a group of "traditional" risk factors, but also more recent studies identified over 100 "novel" ones which may have a role in the disease. Among the latter is the thrombophilia profile of a patient, a pathology well-established for its involvement in venous thromboembolism, but with less studied implications in arterial thrombosis. This paper reviews the literature, explaining the pathophysiology of the thrombophilia causes associated most with coronary thrombosis events. Results of several studies on the subject, including a meta-analysis with over 60,000 subjects, determined the significant involvement of factor V Leiden, prothrombin G20210A mutation, plasminogen activator inhibitor-1 and antiphospholipid syndrome in the development of coronary artery disease. The mechanisms involved are currently at different stages of research, with some already established and used as therapeutic targets.
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Affiliation(s)
- Iris Bararu Bojan
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Stefan Dobreanu
- Recuperare Hospital Iasi, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania (C.B.)
| | - Maria Cristina Vladeanu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Codruta Badescu
- Recuperare Hospital Iasi, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania (C.B.)
| | - Carmen Plesoianu
- Department of Internal Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Nina Filip
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
| | - Dan Iliescu
- Department of Internal Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Otilia Frasinariu
- Department of Pediatry, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Andrei Bojan
- Department of Surgical Sciences, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Razvan Tudor
- Department of Orthopedy, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania; (I.B.B.); (N.F.); (O.V.B.)
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2
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Yuan L, Han J, van der Velden AIM, Vink H, de Mutsert R, Rosendaal FR, van Hylckama Vlieg A, Li-Gao R, Rabelink TJ, van den Berg BM. Sex-specific association between microvascular health and coagulation parameters: the Netherlands Epidemiology of Obesity study. J Thromb Haemost 2023; 21:2585-2595. [PMID: 37301258 DOI: 10.1016/j.jtha.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Microvascular dysfunction is a growing determinant of sex differences in coronary heart disease (CHD). Dysregulation of the coagulation system is involved in CHD pathogenesis and can be induced by endothelial glycocalyx (EG) perturbation. However, little is known about the link between EG function and coagulation parameters in population-based studies on sex specificity. OBJECTIVES We sought to examine the sex differences in the relationship between EG function and coagulation parameters in a middle-aged Dutch population. METHODS Using baseline measurements of 771 participants from the Netherlands Epidemiology of Obesity study (age, 56 years [IQR, 51-61 years]; 53% women; body mass index, 27.9 kg/m2 [IQR, 25.1-30.9 kg/m2]), associations between glycocalyx-related perfused boundary region (PBR) derived using sidestream dark-field imaging and coagulation parameters (factor [F]VIII/IX/XI; thrombin generation parameters; and fibrinogen) were investigated using linear regression analyses, adjusting for possible confounders (including C-reactive protein, leptin, and glycoprotein acetyls), followed by sex-stratified analyses. RESULTS There was a sex difference in the associations between PBR and coagulation parameters. Particularly in women, 1-SD PBR (both total and feed vessel, indicating poorer glycocalyx status) was associated with higher FIX activity ([1.8%; 95% CI, 0.3%-3.3%] and [2.0%; 95% CI, 0.5%-3.4%], respectively) and plasma fibrinogen levels ([5.1 mg/dL; 95% CI, 0.4-9.9 mg/dL] and [5.8 mg/dL; 95% CI, 1.1-10.6 mg/dL], respectively). Furthermore, 1-SD PBRcapillary was associated with higher FVIII activity (3.5%; 95% CI, 0.4%-6.5%) and plasma fibrinogen levels (5.3 mg/dL; 95% CI, 0.6-10.0 mg/dL). CONCLUSION We revealed a sex-specific association between microcirculatory health and procoagulant status, which suggests that microvascular health be considered during early development of CHD in women.
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Affiliation(s)
- Lushun Yuan
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jihee Han
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anouk I M van der Velden
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Vink
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; MicroVascular Health Solutions LLC, Alpine, Utah, USA
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Metabolon Inc, Morrisville, North Carolina, USA
| | - Ton J Rabelink
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bernard M van den Berg
- Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
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3
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Biomarkers of Venous Thromboembolism Recurrence after Discontinuation of Low Molecular Weight Heparin Treatment for Cancer-Associated Thrombosis (HISPALIS-Study). Cancers (Basel) 2022; 14:cancers14112771. [PMID: 35681751 PMCID: PMC9179374 DOI: 10.3390/cancers14112771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
The most appropriate duration of anticoagulant treatment for cancer-associated venous thromboembolism (CAT) remains unclear. We have conducted a prospective multicenter study in CAT patients with more than 6 months of anticoagulant treatment to predict the risk of venous thromboembolism (VTE) recurrence after anticoagulation discontinuation. Blood samples were obtained when patients stopped the anticoagulation, at 21 days and at 90 days. In each sample we assessed different coagulation-related biomarkers: D-dimer (DD), high-sensitivity C-reactive protein (hs-CRP), P-selectin (PS), phospholipids, soluble tissue factor, factor VIII and the thrombin generation test. It was evaluated 325 CAT patients and 166 patients were included in the study, mean age 64 ± 17 years. VTE recurrence until 6 months after stopping anticoagulation treatment was 9.87% [95% confidence interval (CI): 6−15]. The biomarkers sub-distribution hazard ratios were 6.32 for ratio DD basal/DD 21 days > 2 (95% CI: 1.82−21.90), 6.36 for hs-CRP > 4.5 (95% CI: 1.73−23.40) and 5.58 for PS > 40 (95% CI: 1.46−21.30) after 21 days of stopping anticoagulation. This is the first study that has identified the DD ratio, hs-CRP and PS as potential biomarkers of VTE recurrence in cancer patients after the discontinuation of anticoagulation treatment. A risk-adapted strategy may allow the identification of the optimal time to withdraw the anticoagulation in each CAT patient.
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Hansen CH, Cwikiel J, Bratseth V, Arnesen H, Flaa A, Seljeflot I. Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease. Clin Appl Thromb Hemost 2022; 28:10760296221094029. [PMID: 35437054 PMCID: PMC9021467 DOI: 10.1177/10760296221094029] [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] [Indexed: 11/25/2022] Open
Abstract
We examined whether resting levels and exercise-induced changes during exercise ECG stress test (EST) of cardiac Troponin T (cTnT), NT-proBNP and prothrombotic markers were affected by revascularization in patients with coronary artery disease (CAD). EST1 was performed before coronary angiography and revascularization, and patients (n = 20) with confirmed CAD, performed another EST (EST2) 9 weeks later. Blood samples were drawn at rest and within five min after termination of ESTs. cTnT and NT-proBNP increased during exercise at both ESTs (p < 0.001, all). Resting cTnT levels at EST2 versus EST1 were significantly higher (p = 0.02) whereas NT-proBNP did not differ. At both visits, increased D-dimer (p = 0.008 and <0.001), pro-thrombin fragment 1 + 2 (p = 0.009 and 0.001) and tissue factor pathway inhibitor (TFPI) (p < 0.001 and 0.001) during exercise were demonstrated. Resting levels of endogenous thrombin potential (ETP) and TFPI were reduced at EST2 versus EST1 (p < 0.01). Revascularization did not affect exercise-induced release of cardiac and prothrombotic biomarkers and did not reduce resting levels of cTnT or NT-proBNP, suggesting revascularization per se not to prevent secretion of biomarkers. The lower resting levels of ETP and TFPI after revascularization may however, be indicative of reduced thrombin generation and endothelial activation. Clinicaltrials.gov, CADENCE, NCT01495091 https://clinicaltrials.gov/ct2/show/NCT01495091?term = 01495091&draw = 2&rank = 1.
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Affiliation(s)
- C H Hansen
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - J Cwikiel
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway
| | - V Bratseth
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - H Arnesen
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A Flaa
- Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway
| | - I Seljeflot
- Center for Clinical Heart Research, 60504Oslo University Hospital, Ullevaal, Norway.,Department of Cardiology, 155272Oslo University Hospital, Ullevaal, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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5
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Farm M, Antovic A, Schmidt DE, Bark N, Soutari N, Siddiqui AJ, Holmström M, Pruner I, Antovic JP. Diagnostic Accuracy in Acute Venous Thromboembolism: Comparing D-Dimer, Thrombin Generation, Overall Hemostatic Potential, and Fibrin Monomers. TH OPEN 2020; 4:e178-e188. [PMID: 32844145 PMCID: PMC7440969 DOI: 10.1055/s-0040-1714210] [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: 02/05/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction
For acute venous thromboembolism (VTE), a biomarker with higher specificity than D-dimer would be of great clinical use. Thrombin generation and overall hemostatic potential (OHP) reflect the hemostatic balance by globally assessing multiple coagulation factors and inhibitors. These tests discriminate between healthy controls and patients with a prothrombotic tendency but have yet to be established as clinical biomarkers of VTE.
Objective
This study compares endogenous thrombin potential (ETP) and OHP to D-dimer and fibrin monomers (FM) in outpatients with suspected VTE.
Methods
A cross-sectional diagnostic study where 954 patients with suspected pulmonary embolism or deep venous thrombosis were recruited consecutively from the medical emergency department at Karolinska University Hospital. D-dimer, FM, OHP, and ETP were analyzed in a subpopulation of 60 patients with VTE and 98 matched controls without VTE. VTE was verified either by ultrasonography or computed tomography and clinical data were collected from medical records.
Results
Compared with healthy controls, both VTE and non-VTE patients displayed prothrombotic profiles in OHP and ETP. D-dimer, FM, ETP area under the curve (AUC), and ETP T
lag
were significantly different between patients with VTE and non-VTE. The largest receiver-operating characteristic AUCs for discrimination between VTE and non-VTE, were found in D-dimer with 0.94, FM 0.77, and ETP AUC 0.65. No useful cutoff could be identified for the ETP or the OHP assay.
Conclusion
Compared with D-dimer, neither ETP nor OHP were clinically viable biomarkers of acute venous thrombosis. The data indicated that a large portion of the emergency patients with suspected VTE were in a prothrombotic state.
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Affiliation(s)
- Maria Farm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Aleksandra Antovic
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
| | - David E Schmidt
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Coagulation Unit, Division of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Bark
- Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Nida Soutari
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Anwar J Siddiqui
- Emergency Medicine Function, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Holmström
- Division of Diagnostics and Specialist Medicine, Unit of Internal Medicine, Medicine and Caring Sciences, Department of Health, Linköping University, Linköping, Sweden
| | - Iva Pruner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jovan P Antovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
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Boussofara A, Laroussi L, Baccouche H, Bennour E, Kasbaoui S, Triki H, Zied IEH, Kammoun I, Halima AB, Addad F, Marrakchi S, Romdhane NB, Kachboura S. ImpaCt of aspirin regimen on THrombin generation in diabEtic patients with acute coronary syndrome: CARTHaGE-ACS trial. Eur J Clin Pharmacol 2020; 77:517-526. [PMID: 32761372 DOI: 10.1007/s00228-020-02969-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetes is associated with a high rate of events after acute coronary syndrome. It was recently reported that once-daily aspirin might not provide stable biological efficacy in patients with diabetes. AIMS We sought to compare the biological efficacy of aspirin given once a day versus aspirin divided twice per day in a population of diabetic patients with non-ST elevation acute coronary syndrome (NSTE-ACS) as assessed by the thrombin generation test. METHODS We performed an open-label single-blind randomized study including 59 consecutive diabetic patients admitted for NSTE-ACS. Patients were randomly treated with aspirin 100 mg once a day (GA100; n = 20), aspirin 160 mg once a day (GA160; n = 19) or aspirin 100 mg twice a day (G2A100; n = 20). The primary endpoint was endogenous thrombin potential (ETP) at discharge and after 6 months. RESULTS The mean age of our patients was 61.5 ± 9 years, and 73% were male. The baseline characteristics were comparable between the three groups. In the GA100 group, there was no significant effect on ETP variation at 6 months (1150.46 ± 504.84 vs. 1087.63 ± 454.18; p = 0.794). An increase in aspirin dose with a second daily administration of 100 mg was associated with a significant reduction in ETP at 6 months (1004.87 ± 196.2 vs. 1233.63 ± 333.5; p = 0.003). A nonsignificant decrease in ETP was seen in the GA160 group (from 1173.8 ± 388.07 to 1053.64 ± 269.93 at 6 months, p = 0.117). CONCLUSION Only the twice-daily aspirin regimen led to better control of hypercoagulability in NSTE-ACS diabetic patients. However, no thrombin generation normalization was reported.
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Affiliation(s)
- Amine Boussofara
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Lobna Laroussi
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia. .,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia. .,, Residence Diar Ons apartment B 2 1, Riadh El Andalos, 2058, Ariana, Tunisia.
| | - Hela Baccouche
- Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia.,Department of Hematology, Rabta Hospital, Tunis, Tunisia
| | - Emna Bennour
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Sami Kasbaoui
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Hbib Triki
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Ibn El Haj Zied
- Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia.,Taher Maamouri Hospital, Nabeul, Tunisia
| | - Ikram Kammoun
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Afef Ben Halima
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Faouzi Addad
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Sonia Marrakchi
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
| | - Neila Ben Romdhane
- Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia.,Department of Hematology, Rabta Hospital, Tunis, Tunisia
| | - Salem Kachboura
- Department of Cardiology, Abderrahmen Mami Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis- Tunis University El Manar, Tunis, Tunisia
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7
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Langseth MS, Opstad TB, Bratseth V, Solheim S, Arnesen H, Pettersen AÅ, Seljeflot I, Helseth R. Markers of neutrophil extracellular traps are associated with adverse clinical outcome in stable coronary artery disease. Eur J Prev Cardiol 2018; 25:762-769. [PMID: 29473463 DOI: 10.1177/2047487318760618] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Neutrophil extracellular traps, comprising chromatin and granule proteins, have been implicated in atherothrombosis. Design and methods We investigated whether the circulating neutrophil extracellular traps markers, double-stranded DNA and myeloperoxidase-DNA were associated with clinical outcome and hypercoagulability in patients with stable coronary artery disease. Patients with angiographically verified stable coronary artery disease ( n = 1001) were included. Follow-up was 2 years, recording 106 clinical endpoints (unstable angina, non-haemorrhagic stroke, myocardial infarction or death). Serum collected at baseline was used to determine double-stranded DNA and myeloperoxidase-DNA levels. Results The neutrophil extracellular traps markers were weakly intercorrelated ( r = 0.103, P = 0.001). Patients with the highest quartile of double-stranded DNA had weakly but significantly elevated hypercoagulability markers (prothrombin fragment 1+2, D-dimer, free and total tissue factor pathway inhibitor ( P < 0.001 for all)). Men, smokers, patients with metabolic syndrome and patients with a previous myocardial infarction had significantly elevated double-stranded DNA levels ( P ≤ 0.002 for all). Significantly higher double-stranded DNA levels were observed in the group experiencing a clinical endpoint compared to the group without ( P = 0.019). When categorising double-stranded DNA into quartiles, a distinct cut-off between the lowest and upper three quartiles was observed. Adjusting for relevant covariates, patients in the upper three quartiles had an odds ratio of 2.01 (95% confidence interval 1.12, 3.58, P = 0.019) for experiencing a clinical endpoint. Myeloperoxidase-DNA was not significantly associated with clinical outcome or hypercoagulability. Conclusions Double-stranded DNA levels were significantly related to adverse clinical outcome after 2 years, but only weakly associated with hypercoagulability. These observations suggest that the detrimental effects of neutrophil extracellular traps in coronary artery disease might extend beyond those related to hypercoagulability.
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Affiliation(s)
- Miriam Sjåstad Langseth
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - Trine Baur Opstad
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - Vibeke Bratseth
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - Svein Solheim
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,3 Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Harald Arnesen
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - Alf Åge Pettersen
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,4 Department of Cardiology, Ringerike Hospital, Norway
| | - Ingebjørg Seljeflot
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway.,3 Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Ragnhild Helseth
- 1 Center for Clinical Heart Research, Oslo University Hospital Ullevål, Norway.,2 Faculty of Medicine, University of Oslo, Norway
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8
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Dunning M, May J, Adamany J, Heptinstall S, Fox S. A Remote Assay for Measuring Canine Platelet Activation and the Inhibitory Effects of Antiplatelet Agents. J Vet Intern Med 2017; 32:119-127. [PMID: 29197128 PMCID: PMC5787215 DOI: 10.1111/jvim.14845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/16/2017] [Accepted: 08/28/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antiplatelet medications are increasingly used in dogs. Remote analysis of platelet activity is challenging, limiting assessment of antiplatelet drug efficacy. HYPOTHESIS/OBJECTIVES To evaluate a method used in humans for stimulation and remote analysis of canine platelet activity. ANIMALS Forty-five dogs of various ages without a coagulopathy or thrombocytopenia. Six were receiving antiplatelet medication. METHODS Prospective observational study. Platelets were stimulated with combinations of arachidonic acid (AA) and epinephrine (Epi) or adenosine diphosphate (ADP) and the thromboxane A2 -mimetic U46619 (U4). PAMFix was added to the blood samples to facilitate delayed analysis of platelet activity. Activity was assessed by flow cytometric measurement of surface P-selectin (CD62P) expression. RESULTS Canine platelets could be stimulated with both AA/Epi and ADP/U4. The levels of P-selectin were significantly greater than paired, unstimulated samples (P < 0.001). Inhibition of P-selectin expression occurred after this stimulation by adding antiplatelet drugs in vitro. The efficacy of antiplatelet drugs in samples from treated dogs was also measurable ex vivo using this method. Delayed analysis of platelet activity at time points up to 22 days demonstrated excellent correlation between respective mf values at each time point (r2 = 0.92, P < 0.0001). CONCLUSIONS AND CLINICAL IMPORTANCE This study evaluated a new method to remotely assess canine platelet activity. It shows that PAMFix can be used for this purpose. This provides opportunities to interrogate the inhibitory action of antiplatelet drugs in clinical settings.
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Affiliation(s)
- M Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - J May
- Clinical Neuroscience, Queen's Medical Centre, Nottingham, UK
| | - J Adamany
- Pride Veterinary Centre, Derbyshire, UK
| | - S Heptinstall
- Clinical Neuroscience, Queen's Medical Centre, Nottingham, UK
| | - S Fox
- Clinical Neuroscience, Queen's Medical Centre, Nottingham, UK
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9
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Christersson C, Lindahl B, Berglund L, Siegbahn A, Oldgren J. The utility of coagulation activity for prediction of risk of mortality and cardiovascular events in guideline-treated myocardial infarction patients. Ups J Med Sci 2017; 122:224-233. [PMID: 29299952 PMCID: PMC5810226 DOI: 10.1080/03009734.2017.1407849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite improved treatment of myocardial infarction (MI), real-world patients still suffer substantial risk for subsequent cardiovascular events. Little is known about coagulation activity shortly after MI and whether coagulation activity markers may identify patients at increased risk despite contemporary treatment. OBJECTIVE To evaluate D-dimer concentration and thrombin generation potential shortly after discharge after MI and evaluate if these markers could predict the risk of future cardiovascular and bleeding events. METHODS Unselected MI patients (n = 421) were included in the observational REBUS study (NCT01102933) and followed for two years. D-dimer concentrations, thrombin peak, and endogenous thrombin potential (ETP) were analyzed at inclusion (3-5 days after MI) and at early follow-up (after 2-3 weeks). RESULTS Seventy-five patients (17.8%) experienced the composite endpoint (all-cause death, MI, congestive heart failure, or all-cause stroke), and 31 patients (7.4%) experienced a clinically relevant bleeding event. D-dimer concentrations at early follow-up were associated with the composite endpoint (HR [per SD increase] 1.51 [95% CI 1.22-1.87]) and with clinically relevant bleeding (HR [per SD increase] 1.80 [95% CI 1.32-2.44]). Thrombin generation potential was not significantly associated with either the composite endpoint or with clinically relevant bleeding. Higher thrombin peak and ETP at early follow-up were both inversely associated with stroke (HR [per SD increase] 0.50 [95% CI 0.30-0.81] and 0.43 [95% CI 0.22-0.83], respectively). CONCLUSION In unselected MI patients treated according to contemporary guidelines, D-dimer measurements may identify patients at increased risk of new cardiovascular and bleeding events. The inverse association of thrombin generation potential and risk of stroke has to be further investigated.
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Affiliation(s)
- Christina Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- CONTACT Christina Christersson Department of Medical Sciences, Cardiology, Uppsala University, 75185 Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Berglund
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Agneta Siegbahn
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Jonas Oldgren
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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10
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Sabra A, Lawrence MJ, Aubrey R, Obaid D, Chase A, Smith D, Thomas P, Storton S, Davies GR, Hawkins K, Williams PR, Morris K, Evans PA. Characterisation of clot microstructure properties in stable coronary artery disease. Open Heart 2017; 4:e000562. [PMID: 28761676 PMCID: PMC5515126 DOI: 10.1136/openhrt-2016-000562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/20/2017] [Accepted: 04/04/2017] [Indexed: 01/18/2023] Open
Abstract
Background Coronary artery disease (CAD) is associated with an increased prothrombotic tendency and is also linked to unfavourably altered clot microstructure. We have previously described a biomarker of clot microstructure (df) that is unfavourably altered in acute myocardial infarction. The df biomarker assesses whether the blood will form denser or looser microstructures when it clots. In this study we assessed in patients with stable chest pain whether df can differentiate between obstructed and unobstructed CAD. Methods A blood sample prior to angiography was obtained from 251 consecutive patients undergoing diagnostic coronary angiography. Patients were categorised based on angiographic findings as presence or absence of obstructive CAD (stenosis ≥50%). The blood sample was assessed using the df biomarker, standard laboratory markers and platelet aggregometry (Multiplate). Results A significant difference (p=0.028) in df was observed between obstructive CAD (1.748±0.057, n=83) and unobstructive CAD (1.732±0.052, n=168), where patients with significant CAD produce denser, more tightly packed clots. df was also raised in men with obstructive CAD compared with women (1.745±0.055 vs 1.723±0.052, p=0.007). Additionally df significantly correlated with the platelets response to arachidonic acid as measured by the ASPItest area under the curve readings from platelet aggregometry (correlation coefficient=0.166, p=0.008), a low value of the ASPItest indicating effective aspirin use was associated with looser, less dense clots. Conclusions For the first time, we characterise clot microstructure, as measured by df, in patients with stable CAD. df can potentially be used to risk-stratify patients with stable CAD and assess the efficacy of therapeutic interventions by measuring changes in clot microstructure.
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Affiliation(s)
- Ahmed Sabra
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK.,Department of Cardiology, Princess of Wales Hospital, ABMU Health Board, Bridgend, UK
| | - Matthew James Lawrence
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Robert Aubrey
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Daniel Obaid
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Alexander Chase
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Dave Smith
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Phillip Thomas
- Cardiac Centre, Morriston Hospital, ABMU Health Board, Swansea, UK
| | - Sharon Storton
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Gareth R Davies
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | - Karl Hawkins
- NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK
| | | | - Keith Morris
- School of Applied Science, Cardiff Metropolitan University, Cardiff, UK
| | - Phillip Adrian Evans
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, ABMU Health Board, Swansea, UK.,NISCHR Haemostasis Biomedical Research Unit, College of Medicine, Swansea University, Swansea, UK.,Department of Emergency Medicine, Morriston Hospital, ABMU Health Board, Swansea, UK
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11
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Wexels F, Dahl OE, Pripp AH, Seljeflot I. Thrombin Generation in Patients With Suspected Venous Thromboembolism. Clin Appl Thromb Hemost 2017; 23:416-421. [DOI: 10.1177/1076029617700999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Increasing number of patients with clinically suspected venous thromboembolism is referred to radiological departments for definitive diagnosis. A simple assay to exclude the diagnosis and avoid radiological examinations is needed. We have reported correlations between D-dimer and prothrombin fragment 1 + 2 measured in plasma and urine. To further develop an analysis based on urine, more understanding of thrombin generation in these patients is needed. The aim of this study was to compare ex vivo thrombin generation with in vivo markers in plasma and urine in patients with and without venous thromboembolism. Urine and blood samples were collected from patients with suspected venous thromboembolism. Commercially available enzyme-linked immunosorbent assay (ELISA) kits were used to analyze the samples for in vivo thrombin generation. The ex vivo thrombogram parameters were measured by the calibrated automated thrombogram assay. Venous thromboembolism was verified with compression ultrasound of the lower extremity deep veins or with computer tomography of the pulmonary arteries. Venous thromboembolism was diagnosed in 117 of 591 patients, and they had significantly higher levels of urine and plasma prothromin fragment 1 + 2, D-dimer, lag time, time to peak, and endogenous thrombin potential when adjusted for covariates. The pattern of ex vivo and in vivo thrombin generation in patients with suspected venous thromboembolism was comparable when adjusted for covariates. Prothrombin fragment 1 + 2 in plasma and urine reflects thrombin generation ex vivo in the same manner. This indicates that urine may be an alternative substrate to quantify a procoagulant state.
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Affiliation(s)
- Fredrik Wexels
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are H. Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ingebjørg Seljeflot
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
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12
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Chang X, Chin HL, Quek SC, Goh DYT, Dorajoo R, Friedlander Y, Heng CK. The genetic variation rs6903956 in the novel androgen-dependent tissue factor pathway inhibitor regulating protein ( ADTRP) gene is not associated with levels of plasma coagulation factors in the Singaporean Chinese. Thromb J 2017; 15:1. [PMID: 28074087 PMCID: PMC5219704 DOI: 10.1186/s12959-016-0124-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genome-wide association study (GWAS) has reported that rs6903956 within the first intron of androgen-dependent tissue factor pathway inhibitor (TFPI) regulating protein (ADTRP) gene is associated with coronary artery disease (CAD) risk in the Chinese population. Although ADTRP is believed to be involved in the upregulation of TFPI, the underlying mechanism involved is largely unknown. This study investigated the association of rs6903956 with plasma Factor VII coagulant activity (FVIIc) and fibrinogen levels, which are regulated by TFPI and are independent risk predictors for CAD. METHODS We conducted the analysis in both Chinese adult (N = 309) and neonatal cohorts (N = 447). The genotypes of the rs6903956 single nucleotide polymorphism (SNP) were determined by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). FVIIc and fibrinogen level were measured from citrated plasma. The association between rs6903956 and coagulation factors was tested by linear regression with adjustment for possible confounders. Analysis was carried out in adults and neonates separately. RESULTS No significant association was observed between rs6903956 and plasma FVIIc nor fibrinogen levels with adjustment for age, gender, body mass index (BMI) and cigarette smoking in adults (P for FVIIc = 0.464; P for fibrinogen = 0.349). The SNP was also not associated with these two coagulation factors in the neonates (P for FVIIc = 0.579; P for fibrinogen = 0.359) after adjusting for gestational age, gender and birth weight. CONCLUSIONS SNP rs6903956 on ADTRP gene was not associated with plasma FVIIc nor fibrinogen levels.
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Affiliation(s)
- Xuling Chang
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Hui-Lin Chin
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Swee-Chye Quek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Daniel Y T Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Rajkumar Dorajoo
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yechiel Friedlander
- School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chew-Kiat Heng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
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13
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Hansen CH, Ritschel V, Halvorsen S, Andersen GØ, Bjørnerheim R, Eritsland J, Arnesen H, Seljeflot I. Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction. Thromb J 2015; 13:31. [PMID: 26396552 PMCID: PMC4578351 DOI: 10.1186/s12959-015-0061-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/12/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Platelet activation, thrombin generation and fibrin formation play important roles in intracoronary thrombus formation, which may lead to acute myocardial infarction. We investigated whether the prothrombotic markers D-dimer, pro-thrombin fragment 1 + 2 (F1 + 2) and endogenous thrombin potential (ETP) are associated with myocardial necrosis assessed by Troponin T (TnT), and left ventricular impairment assessed by left ventricular ejection fraction (LVEF) and N-terminal pro b-type natriuretic peptide (NT-proBNP). Materials/Methods Patients (n = 987) with ST-elevation mycardial infarction (STEMI) were included. Blood samples were drawn at a median time of 24 h after onset of symptoms. Results Statistically significant correlations were found between both peak TnT and D-dimer (p < 0.001) and F1 + 2 (p < 0.001), and between NT-proBNP and D-dimer (p = 0.001) and F1 + 2 (p < 0.001). When dividing TnT and NT-proBNP levels into quartiles there were significant trends for increased levels of both markers across quartiles (all p < 0.001) D-dimer remained significantly associated with NT-proBNP after adjustments for covariates (p = 0.001) whereas the association between NTproBNP and F1 + 2 was no longer statistically significant (p = 0.324). A significant inverse correlation was found between LVEF and D-dimer (p < 0.001) and F1 + 2 (p = 0.013). When dichotomizing LVEF levels at 40 %, we observed significantly higher levels of both D-dimer (p < 0.001) and F1 + 2 (p = 0.016) in the group with low EF (n = 147). Summary/conclusion In our cohort of STEMI patients we demonstrated that levels of D-dimer and F1 + 2 were significantly associated with myocardial necrosis as assessed by peak TnT. High levels of these coagulation markers in patients with low LVEF and high NTproBNP may indicate a hypercoagulable state in patients with impaired myocardial function.
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Affiliation(s)
- C H Hansen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - V Ritschel
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Halvorsen
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - G Ø Andersen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - R Bjørnerheim
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - J Eritsland
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - H Arnesen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - I Seljeflot
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
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14
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Loeffen R, Godschalk TC, van Oerle R, Spronk HMH, Hackeng CM, ten Berg JM, ten Cate H. The hypercoagulable profile of patients with stent thrombosis. Heart 2015; 101:1126-32. [PMID: 25999588 PMCID: PMC4515992 DOI: 10.1136/heartjnl-2014-306685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/05/2015] [Indexed: 01/10/2023] Open
Abstract
Objective Coronary stent thrombosis is a devastating complication after percutaneous coronary intervention (PCI). The mechanisms underlying stent thrombosis are multifactorial. Whether the coagulation system is involved in the pathophysiology of stent thrombosis is unclear. We hypothesised that thrombin generation, reflecting the coagulation potential, is enhanced in patients with stent thrombosis. Methods A case–control study was performed, including 63 patients with PCI: 23 cases (stent thrombosis) and 40 controls (no stent thrombosis). Thrombin generation was measured using 0, 1 and 5 pM tissue factor (TF) triggers. Active site-inhibited factor VIIa (ASIS) and recombinant thrombomodulin were added to study the contact activation system and the protein C pathway, respectively. Results Thrombin generation was significantly increased for all TF triggers in cases compared with controls. Addition of ASIS to the measurement without exogenous TF revealed significantly enhanced contact activation in cases compared with controls; mean peak height: 241 vs 183 nM. Thrombin generation was also significantly increased in cases compared with controls in the presence of exogenous TF; mean peak height: 263 vs 233 nM (5 pM TF). Addition of thrombomodulin reduced thrombin generation by 23% in cases and 31% in controls (p<0.018), suggesting alterations in the protein C pathway in cases. Conclusions This is the first study that suggests the involvement of the coagulation system in stent thrombosis. Stent thrombosis patients showed a hypercoagulable state, most likely caused by enhanced contact activation and attenuation of anticoagulation by the protein C pathway.
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Affiliation(s)
- R Loeffen
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T C Godschalk
- Department of Cardiology, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R van Oerle
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - H M H Spronk
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C M Hackeng
- Department of Clinical Chemistry, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M ten Berg
- Department of Cardiology, St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H ten Cate
- Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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15
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Albini P, Barshes NR, Russell L, Wu D, Coselli JS, Shen YH, Allison PM, LeMaire SA. D-dimer levels remain elevated in acute aortic dissection after 24 h. J Surg Res 2014; 191:58-63. [DOI: 10.1016/j.jss.2014.03.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/20/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022]
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16
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Rooth E, Sobocinski-Doliwa P, Antovic J, Frykman Kull V, Von Arbin M, Rosenqvist M, Wallén H. Thrombin generation in acute cardioembolic and non-cardioembolic ischemic stroke. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:576-84. [PMID: 24063505 DOI: 10.3109/00365513.2013.826817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Increased thrombin generation, as measured by the Calibrated Automated Thrombogram (CAT), has recently been reported to predict ischemic stroke, especially stroke with a cardioembolic source. However, there are few studies on thrombin generation using CAT in patients with manifest ischemic stroke, particularly in patients with cardioembolic stroke not yet on anticoagulation. MATERIALS AND METHODS Therefore, a prospective cohort study of 205 stroke patients > 45 years of age was performed. They were recruited during their hospital stay or shortly thereafter. Inclusion criteria were ischemic stroke or TIA within two weeks and no atrial fibrillation (AF) in the history or at inclusion. Patients received a thumb ECG device in order to detect silent AF. Blood samples were collected at inclusion and after 1 month. Thrombin generation in plasma after addition of tissue factor was assessed in patients and in healthy controls. RESULTS Mean age of patients was 72 ± 7 years and 43% were females. Peak thrombin concentrations were variable among stroke patients but overall significantly higher at both time points (p < 0.0001) compared to controls, and tended to be highest in patients in whom paroxysmal atrial fibrillation was subsequently documented. CONCLUSION Thrombin generation in patients with acute cardioembolic and non-cardioembolic schemic stroke/TIA is variable but overall higher compared to healthy subjects. The long-term prognostic value of thrombin generation in patients with a recent ischemic stroke deserves further investigation.
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Affiliation(s)
- Elisabeth Rooth
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital
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17
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Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome. Pulm Med 2013; 2013:521087. [PMID: 23936649 PMCID: PMC3712227 DOI: 10.1155/2013/521087] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/24/2013] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation). It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients.
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