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Kopytek M, Ząbczyk M, Mazur P, Undas A, Natorska J. PAI-1 Overexpression in Valvular Interstitial Cells Contributes to Hypofibrinolysis in Aortic Stenosis. Cells 2023; 12:1402. [PMID: 37408236 DOI: 10.3390/cells12101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Aortic stenosis (AS) is associated with hypofibrinolysis, but its mechanism is poorly understood. We investigated whether LDL cholesterol affects plasminogen activator inhibitor 1 (PAI-1) expression, which may contribute to hypofibrinolysis in AS. Stenotic valves were obtained from 75 severe AS patients during valve replacement to assess lipids accumulation, together with PAI-1 and nuclear factor-κB (NF-κB) expression. Five control valves from autopsy healthy individuals served as controls. The expression of PAI-1 in valve interstitial cells (VICs) after LDL stimulation was assessed at protein and mRNA levels. PAI-1 activity inhibitor (TM5275) and NF-κB inhibitor (BAY 11-7082) were used to suppress PAI-1 activity or NF-κB pathway. Clot lysis time (CLT) was performed to assess fibrinolytic capacity in VICs cultures. Solely AS valves showed PAI-1 expression, the amount of which was correlated with lipid accumulation and AS severity and co-expressed with NF-κB. In vitro VICs showed abundant PAI-1 expression. LDL stimulation increased PAI-1 levels in VICs supernatants and prolonged CLT. PAI-1 activity inhibition shortened CLT, while NF-κB inhibition decreased PAI-1 and SERPINE1 expression in VICs, its level in supernatants and shortened CLT. In severe AS, valvular PAI-1 overexpression driven by lipids accumulation contributes to hypofibrinolysis and AS severity.
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Affiliation(s)
- Magdalena Kopytek
- Thromboembolic Disorders Department, Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202 Krakow, Poland
- Krakow Centre for Medical Research and Technologies, John Paul II Hospital, 80 Pradnicka St., 31-202 Krakow, Poland
| | - Michał Ząbczyk
- Thromboembolic Disorders Department, Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202 Krakow, Poland
- Krakow Centre for Medical Research and Technologies, John Paul II Hospital, 80 Pradnicka St., 31-202 Krakow, Poland
| | - Piotr Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202 Krakow, Poland
| | - Anetta Undas
- Thromboembolic Disorders Department, Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202 Krakow, Poland
- Krakow Centre for Medical Research and Technologies, John Paul II Hospital, 80 Pradnicka St., 31-202 Krakow, Poland
| | - Joanna Natorska
- Thromboembolic Disorders Department, Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202 Krakow, Poland
- Krakow Centre for Medical Research and Technologies, John Paul II Hospital, 80 Pradnicka St., 31-202 Krakow, Poland
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2
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Brailovsky Y, Lakhter V, Newman J, Allen S, Elkaryoni A, Desai P, Masic D, Bechara CF, Bontekoe E, Hoppensteadt D, Lopez JJ, Siddiqui F, Iqbal O, Fareed J, Darki A. Fibrinolytic Status and Risk of Death After Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2023; 29:10760296231162079. [PMID: 36911974 PMCID: PMC10014973 DOI: 10.1177/10760296231162079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (PE) is a heterogeneous disease process with variable presentation and outcomes. The endogenous fibrinolytic system is a complex framework of regulatory pathways that maintains homeostasis by dissolving overabundant thrombi. We sought to investigate phenotypic profiles of the endogenous fibrinolytic system among patients presenting with acute PE and their impact on mortality. METHODS We enrolled all consecutive patients with acute PE in our institutional Pulmonary Embolism Response Team registry. We collected blood samples at the time of PE diagnosis and analyzed concentrations of plasminogen activator inhibitor 1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and alpha-2-antiplasmin (A2A). We assessed the association of concentration of fibrinolytic inhibitors and 1-year all-cause mortality and various echocardiographic markers of right ventricular (RV) dysfunction. RESULTS There is significant variability of PAI-1, A2A, and TAFI concentrations across the spectrum of PE risk profiles with high PAI-1, low TAFI, and low A2A (herein referred to as a high-risk biomarker profile) correlating with worse PE severity. High-risk biomarker profile correlated with high-risk echocardiographic features of RV dysfunction, including increased RV/left ventricular (LV) ratio, low tricuspid annular plane systolic excursion, and low right ventricular outflow tract velocity time integral. Higher-risk biomarker profile was able to discriminate and independently identify patients at high risk of all-cause mortality (Group 2 HR 6 95% CI 1.3-27.8, Group 3 HR 12, 95% CI 1.7-86). CONCLUSIONS Further studies are needed to assess the exact pathophysiological link between fibrinolytic status and poor outcome after acute PE and to ascertain the impact of anti-inhibitors of the fibrinolytic system on response to therapy and outcomes after acute PE.
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Affiliation(s)
- Yevgeniy Brailovsky
- Jefferson Heart Institute, Sidney Kimmel School of Medicine, 23217Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Joshua Newman
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Sorcha Allen
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Ahmed Elkaryoni
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Parth Desai
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Dalila Masic
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Carlos F Bechara
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Emily Bontekoe
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Debra Hoppensteadt
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - John J Lopez
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Fakiha Siddiqui
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Omer Iqbal
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Amir Darki
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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3
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Yuan Q, Yu L, Wang F. Efficacy of using thromboelastography to detect coagulation function and platelet function in patients with acute cerebral infarction. Acta Neurol Belg 2021; 121:1661-1667. [PMID: 32757100 DOI: 10.1007/s13760-020-01456-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Thromboelastography (TEG) is commonly used to predict coagulation state in patients with active bleeding. However, the correlation between TEG parameters and conventional tests in patients with cerebrovascular disease (CVD) remains unexplored. Here, we assessed the TEG values and their correlation with conventional tests in patients with acute cerebral infarction. Eighty-eight patients with acute cerebral infarction were enrolled from the Department of Neurology of Suzhou Medical School. Thirty healthy controls were enrolled from the preventive care department in the same hospital who were taking a physical examination. TEG 5000 thromboelastogram system was used to obtain TEG parameters. The automatic blood coagulation analyzer was used to measure the activated partial thromboplastin time (APTT), prothrombin time (PT), D-Dimer (DD) and fibrinogen (FIB) and platelet function. Among five TEG parameters, the R and K value decreased while MA value, alpha angle and CI value increased in patient group when compared with the healthy controls. The correlation between TEG parameters and conventional tests including DD, FIB, and platelet function are consistent with the high coagulation state in the patient group. Our results demonstrate that TEG parameters are sensitive indicators of high coagulation state in patients with acute cerebral infarction.
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4
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Zeng Z, Nallan Chakravarthula T, Muralidharan C, Hall A, Linnemann AK, Alves NJ. Fluorescently conjugated annular fibrin clot for multiplexed real-time digestion analysis. J Mater Chem B 2021; 9:9295-9307. [PMID: 34698753 DOI: 10.1039/d1tb02088a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Impaired fibrinolysis has long been considered as a risk factor for venous thromboembolism. Fibrin clots formed at physiological concentrations are promising substrates for monitoring fibrinolytic performance as they offer clot microstructures resembling in vivo. Here we introduce a fluorescently labeled fibrin clot lysis assay which leverages a unique annular clot geometry assayed using a microplate reader. A physiologically relevant fibrin clotting formulation was explored to achieve high assay sensitivity while minimizing labeling impact as fluorescence isothiocyanate (FITC)-fibrin(ogen) conjugations significantly affect both fibrin polymerization and fibrinolysis. Clot characteristics were examined using thromboelastography (TEG), turbidity, scanning electron microscopy, and confocal microscopy. Sample fibrinolytic activities at varying plasmin, plasminogen, and tissue plasminogen activator (tPA) concentrations were assessed in the present study and results were compared to an S2251 chromogenic assay. The optimized physiologically relevant clot substrate showed minimal reporter-conjugation impact with nearly physiological clot properties. The assay demonstrated good reproducibility, wide working range, kinetic read ability, low limit of detection, and the capability to distinguish fibrin binding-related lytic performance. In combination with its ease for multiplexing, it also has applications as a convenient platform for assessing patient fibrinolytic potential and screening thrombolytic drug activities in personalized medical applications.
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Affiliation(s)
- Ziqian Zeng
- Department of Emergency Medicine, Indiana University School of Medicine, 635 Barnhill Dr Rm. 2063, Indianapolis, IN 46202, USA. .,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Tanmaye Nallan Chakravarthula
- Department of Emergency Medicine, Indiana University School of Medicine, 635 Barnhill Dr Rm. 2063, Indianapolis, IN 46202, USA. .,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Charanya Muralidharan
- Department of Biochemistry & Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Abigail Hall
- Department of Emergency Medicine, Indiana University School of Medicine, 635 Barnhill Dr Rm. 2063, Indianapolis, IN 46202, USA.
| | - Amelia K Linnemann
- Department of Biochemistry & Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Nathan J Alves
- Department of Emergency Medicine, Indiana University School of Medicine, 635 Barnhill Dr Rm. 2063, Indianapolis, IN 46202, USA. .,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA.,Department of Biochemistry & Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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5
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Metabolic Syndrome Increases Risk of Venous Thromboembolism Recurrence after Acute Pulmonary Embolism. Ann Am Thorac Soc 2021; 17:821-828. [PMID: 32187500 DOI: 10.1513/annalsats.201907-518oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Rationale: Metabolic syndrome (MetS), the clinical clustering of hypertension, dyslipidemia, insulin resistance, and abdominal obesity, has been associated with a prothrombotic and hypofibrinolytic state, although data linking MetS with venous thromboembolism (VTE) remain limited.Objectives: The aim of this study was to measure the prevalence of MetS in patients with pulmonary embolism (PE) across a large population and to examine its impact on VTE recurrence.Methods: This was a retrospective, population-based analysis using deidentified information from a large statewide database, the Indiana Network for Patient Care. All patients with an International Classification of Diseases-defined diagnosis of PE from 2004 to 2017 were included. We measured the frequency with which patients with PE carried a comorbid diagnosis of each MetS component. Multiple logistic regression analysis was performed with VTE recurrence as the dependent variable to test the independent effect of MetS diagnosis, with a statistical model using a directed acyclic graph to account for potential confounders and mediators. Kaplan-Meier curves were constructed to compare rates of VTE recurrence over time based on the presence or absence of MetS and its individual components.Results: A total of 72,936 patients were included in this analysis. The most common MetS component was hypertension with a prevalence of 59%, followed by hyperlipidemia (41%), diabetes mellitus (24%), and obesity (22%). Of these patients, 69% had at least one comorbid component of MetS. The overall incidence of VTE recurrence was 17%, increasing stepwise with each additional MetS component and ranging from 6% in patients with zero components to 37% in those with all four. Logistic regression analysis yielded an adjusted odds ratio of 3.03 (95% CI, 2.90-3.16) for the effect of composite diagnosis requiring at least three of the four components of MetS diagnosis on VTE recurrence.Conclusions: The presence of comorbid MetS in patients with PE is associated with significantly higher rates of VTE recurrence, supporting the importance of recognizing these risk factors and initiating appropriate therapies to reduce recurrence risk.
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6
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Metabolic syndrome increases risk of venous thromboembolism recurrence after acute deep vein thrombosis. Blood Adv 2021; 4:127-135. [PMID: 31917844 DOI: 10.1182/bloodadvances.2019000561] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023] Open
Abstract
An improved understanding of which patients are at higher risk of recurrent venous thromboembolism (VTE) is important to designing interventions to reduce degraded quality of life after VTE. Although metabolic syndrome (MetS), the clustering of hypertension, hyperlipidemia, diabetes mellitus, and obesity has been associated with a hypofibrinolytic state, data linking VTE recurrence with MetS remain limited. The purpose of this study was to measure the prevalence of MetS in patients with deep vein thrombosis (DVT) across a large population and determine its effect on VTE recurrence. This was a retrospective analysis of a large statewide database from 2004 to 2017. We measured the frequency with which patients with DVT carried a comorbid International Coding of Diseases diagnosis of MetS components. Association of MetS with VTE recurrence was tested with a multiple logistic regression model and VTE recurrence as the dependent variable. Risk of VTE recurrence conferred by each MetS component was assessed by Kaplan-Meier curves with the log-rank statistic. A total of 151 054 patients with DVT were included in this analysis. Recurrence of VTE occurred in 17% overall and increased stepwise with each criterion for MetS. All 4 components of MetS had significant adjusted odds ratios (OR) for VTE recurrence, with hyperlipidemia having the largest (OR, 1.8), representing the 4 largest ORs of all possible explanatory variables. All 4 MetS variables were significant on Kaplan-Meier analysis for recurrence of VTE. These data imply a role for appropriate therapies to reduce the effects of MetS as a way to reduce risk of VTE recurrence.
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7
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Abstract
Fibrinolysis is of paramount importance in maintaining or regaining the patency of veins and pulmonary arteries obstructed by thrombi. Growing experimental and clinical evidence indicates that impaired fibrinolysis mediated by multiple complex mechanisms is involved in venous thromboembolism (VTE). Global plasma fibrin clot lysis markers, especially clot lysis time, have been reported to predict recurrent deep-vein thrombosis and pulmonary embolism. The current overview summarizes available data linking fibrinolysis to VTE and its long-term sequelae.
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Affiliation(s)
- Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Krakow Centre for Medical Research and Technologies, John Paul II Hospital, Krakow, Poland
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8
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Bachler M, Bösch J, Stürzel DP, Hell T, Giebl A, Ströhle M, Klein SJ, Schäfer V, Lehner GF, Joannidis M, Thomé C, Fries D. Impaired fibrinolysis in critically ill COVID-19 patients. Br J Anaesth 2020; 126:590-598. [PMID: 33422287 PMCID: PMC7833514 DOI: 10.1016/j.bja.2020.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Critically ill coronavirus disease 2019 (COVID-19) patients present with a hypercoagulable state with high rates of macrovascular and microvascular thrombosis, for which hypofibrinolysis might be an important contributing factor. Methods We retrospectively analysed 20 critically ill COVID-19 patients at Innsbruck Medical University Hospital whose coagulation function was tested with ClotPro® and compared with that of 60 healthy individuals at Augsburg University Clinic. ClotPro is a viscoelastic whole blood coagulation testing device. It includes the TPA test, which uses tissue factor (TF)-activated whole blood with added recombinant tissue-derived plasminogen activator (r-tPA) to induce fibrinolysis. For this purpose, the lysis time (LT) is measured as the time from when maximum clot firmness (MCF) is reached until MCF falls by 50%. We compared COVID-19 patients with prolonged LT in the TPA test and those with normal LT. Results Critically ill COVID-19 patients showed hypercoagulability in ClotPro assays. MCF was higher in the EX test (TF-activated assay), IN test (ellagic acid-activated assay), and FIB test (functional fibrinogen assay) with decreased maximum lysis (ML) in the EX test (hypofibrinolysis) and highly prolonged TPA test LT (decreased fibrinolytic response), as compared with healthy persons. COVID-19 patients with decreased fibrinolytic response showed higher fibrinogen levels, higher thrombocyte count, higher C-reactive protein levels, and decreased ML in the EX test and IN test. Conclusion Critically ill COVID-19 patients have impaired fibrinolysis. This hypofibrinolytic state could be at least partially dependent on a decreased fibrinolytic response.
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Affiliation(s)
- Mirjam Bachler
- Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Johannes Bösch
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria.
| | - Daniel P Stürzel
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria
| | - Tobias Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Andreas Giebl
- Department of Transfusion Medicine and Haemostaseology, Augsburg University Clinic, Augsburg, Germany
| | - Mathias Ströhle
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria
| | - Sebastian J Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria
| | - Volker Schäfer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria
| | - Georg F Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck, Austria
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9
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Stewart LK, Kline JA. Fibrinolytics for the treatment of pulmonary embolism. Transl Res 2020; 225:82-94. [PMID: 32434005 PMCID: PMC7487055 DOI: 10.1016/j.trsl.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
The use of fibrinolytic agents in acute pulmonary embolism (PE), first described over 50 years ago, hastens the resolution of RV stain, leading to earlier hemodynamic improvement. However, this benefit comes at the increased risk of bleeding. The strongest indication for fibrinolysis is in high-risk PE, or that characterized by sustained hypotension, while its use in patients with intermediate-risk PE remains controversial. Fibrinolysis is generally not recommended for routine use in intermediate-risk PE, although most guidelines advise that it may be considered in patients with signs of acute decompensation and an overall low bleeding risk. The efficacy of fibrinolysis often varies significantly between patients, which may be at least partially explained by several factors found to promote resistance to fibrinolysis. Ultimately, treatment decisions should carefully weigh the risks and benefits of the individual clinical scenario at hand, including the overall severity, the patient's bleeding risk, and the presence of factors known to promote resistance to fibrinolysis. This review aims to further explore the use of fibrinolytic agents in the treatment of PE including specific indications, outcomes, and special considerations.
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Affiliation(s)
- Lauren K Stewart
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana
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10
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Sista AK. Fibrinogen Monitoring during Catheter-Directed Thrombolysis for Pulmonary Embolism: Can It Be Cleaved from Our Practice? J Vasc Interv Radiol 2020; 31:1290-1291. [DOI: 10.1016/j.jvir.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
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11
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Fibrin clot formation under diverse clotting conditions: Comparing turbidimetry and thromboelastography. Thromb Res 2020; 187:48-55. [PMID: 31954276 DOI: 10.1016/j.thromres.2020.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
Thrombosis is a leading cause of death around the world. Fibrin, the protein primarily responsible for clot formation, is formed via cleaving soluble fibrinogen by thrombin with resulting properties varying under different clot forming conditions. This study sought to compare trends across thromboelastography (TEG) and turbidimetry utilizing a simplified fibrinogen/thrombin clot model. Turbidimetry is an optical measure (550 nm) of fibrin clot formation and is widely utilized due to its laboratory accessibility and ease of use. Thromboelastography (TEG) is a specialized viscoelastic technique that directly measures clot strength and is primarily utilized in the clinical setting to assess patients' hemostasis. In these experiments, human and bovine fibrin clots were formed in-vitro by mixing fibrinogen and thrombin under diverse clotting conditions. Increasing thrombin concentration (0 to 10 U/mL), ionic strength (0.05 to 0.3 M), pH (5.5 to 8.1), and lowering albumin concentration (100 to 0 mg/mL) resulted in decreased clot turbidity and increased clot strength using species-matched bovine and human fibrinogen and thrombin. Whereas, increasing fibrinogen concentration (1 to 5 mg/mL) resulted in increased clot turbidity and increased clot strength for both species-matched and cross-species fibrinogen and thrombin. Clotting times with both techniques followed a similar trend and were observed to be unchanged when varying albumin concentration, elongated with increasing fibrinogen, and shortened with increasing pH, ionic strength, and thrombin. TEG and turbidimetry track clot formation via two distinct methods and when utilized together provide complementary clot strength and fiber structural information across diverse clotting conditions.
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12
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Ilich A, Noubouossie DF, Henderson M, Ellsworth P, Betbadal KF, Campello E, Meeks S, Dunn A, Park MS, Pawlinski R, Simioni P, Shapiro A, Key NS. Development and application of global assays of hyper- and hypofibrinolysis. Res Pract Thromb Haemost 2020; 4:46-53. [PMID: 31989084 PMCID: PMC6971323 DOI: 10.1002/rth2.12275] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 01/01/2023] Open
Abstract
Numerous methods for evaluation of global fibrinolytic activity in whole blood or plasma have been proposed, with the majority based on tissue-type plasminogen activator (t-PA) addition to initiate fibrinolysis. We propose that such an approach is useful to reveal hypofibrinolysis, but t-PA concentrations should be kept to a minimum. In this paper, we describe a low-concentration t-PA plasma turbidity assay to evaluate several congenital factor deficiencies, including plasminogen activator inhibitor-1 (PAI-1) and plasminogen deficiency, as well as hemophilia A and B. In addition, we demonstrate a threshold dependency on endogenous PAI-1 levels. To assess endogenous hyperfibrinolysis, we suggest that assays that avoid t-PA addition are preferable, with assays based on euglobulin fractionation remaining a viable choice. We describe a euglobulin fraction clot lysis time (ECLT) assay with spectrophotometric readout and other modifications, and evaluate it as a tool to measure hyperfibrinolysis in inherited clotting factor deficiency states. We demonstrate that the ECLT is predominantly driven by residual amounts of PAI-1, t-PA, and α2-antiplasmin. These assays should be further evaluated for the detection of hypo- or hyperfibrinolysis in acquired thrombotic or hemorrhagic disorders.
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Affiliation(s)
- Anton Ilich
- Department of MedicineUniversity of North CarolinaChapel HillNorth Carolina
| | | | - Michael Henderson
- Department of MedicineUniversity of North CarolinaChapel HillNorth Carolina
| | - Patrick Ellsworth
- Department of MedicineUniversity of North CarolinaChapel HillNorth Carolina
| | | | - Elena Campello
- Thrombotic and Hemorrhagic Diseases UnitDepartment of MedicineUniversity of PadovaPadovaItaly
| | - Shannon Meeks
- Department of PediatricsEmory UniversityAflac Cancer and Blood Disorders CenterChildren’s Healthcare of AtlantaAtlantaGeorgia
| | - Amy Dunn
- Nationwide Children’s HospitalColumbusOhio
| | - Myung S. Park
- Trauma, Critical Care and General SurgeryMayo ClinicRochesterMinnesota
| | - Rafal Pawlinski
- Department of MedicineUniversity of North CarolinaChapel HillNorth Carolina
| | - Paolo Simioni
- Thrombotic and Hemorrhagic Diseases UnitDepartment of MedicineUniversity of PadovaPadovaItaly
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis CenterIndianapolisIndiana
| | - Nigel S. Key
- Department of Pathology and Laboratory MedicineUniversity of North CarolinaChapel HillNorth Carolina
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13
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Stewart LK, Beam DM, Casciani T, Cameron SJ, Kline JA. Effect of metabolic syndrome on mean pulmonary arterial pressures in patients with acute pulmonary embolism treated with catheter-directed thrombolysis. Int J Cardiol 2019; 302:138-142. [PMID: 31948673 DOI: 10.1016/j.ijcard.2019.12.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/07/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with a procoagulant and hypofibrinolytic state. Current data exploring the role of MetS in venous thromboembolism (VTE) are limited. The objective was to measure the prevalence of MetS in patients with acute PE receiving catheter-directed thrombolysis (CDT) and to investigate its effect on mean pulmonary arterial pressure and overall treatment success. METHODS We used a 3-year prospective registry of ED patients with acute PE with severity qualifying for activation of a PE response team (PERT). All patients had CDT with catheter-measured mPAP and angiography. The presence or absence of MetS components were extracted from chart review based on the following criteria: 1. body mass index (BMI) >30 kg/m2; 2. diagnosed hypertension; 3. diabetes mellitus (including HbA1c >6.5%) and; 4. dyslipidemia (including triglycerides >150 mg/dL or high-density lipoprotein <40 mg/dL). RESULTS Of the 134 patients, 85% met the criteria for at least one of four MetS components, with obesity being most common, present in 71%. Results demonstrated a positive concordance between the number of criteria for MetS and MPAP, both pre- and post-fibrinolysis, as pressures tended to increase with each additional MetS criterion. Multivariate regression analysis determined age (-), BMI (+) and hypertension (+) to be significant independent predictor variables for mPAP. CONCLUSIONS MetS was common in patients with more severe manifestations of PE and was associated with higher mPAP values both at diagnosis and following treatment with CDT.
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Affiliation(s)
- Lauren K Stewart
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Daren M Beam
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Thomas Casciani
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Scott J Cameron
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Jeffrey A Kline
- Department of Emergency Medicine, Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America.
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Comparison of acute and convalescent biomarkers of inflammation in patients with acute pulmonary embolism treated with systemic fibrinolysis vs. placebo. Blood Coagul Fibrinolysis 2018; 28:675-680. [PMID: 28957940 DOI: 10.1097/mbc.0000000000000669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Previous studies have associated biomarkers indicative of acute inflammation with pulmonary embolism, which may amplify coagulation, inhibit fibrinolysis and increase risk of venous thromboembolism (VTE) recurrence. The aim of this study was to measure inflammatory and hemostatic biomarkers in acute submassive pulmonary embolism at diagnosis and 3-month follow-up and to test the impact of treatment with fibrinolysis. Secondary analysis of a multicenter, double-blinded, randomized controlled trial including patients with submassive pulmonary embolism. Blood samples were obtained within 24 h of diagnosis and prior to bolus-dose tenecteplase (TNK) or placebo; all patients received standard anticoagulation and blood was redrawn 3 months later. Plasma concentrations of inflammatory [Interleukin 6 (IL-6), C-reactive protein (CRP), myeloperoxidase (MPO)] and hemostatic [plasminogen activator inhibitor-1 (PAI-1), fibrinogen, thrombin-activatable fibrinolysis inhibitor and D-dimer] biomarkers were quantified. The median values of the biomarkers of inflammation (IL-6, CRP, MPO) were all significantly decreased at 3-month follow-up, ranging from a 60 to 91% reduction over this time period. Concentrations of PAI-1 and fibrinogen did not change significantly. D-dimer concentration at 3-month follow-up was lower in patients treated with fibrinolysis vs. placebo and appeared to have a trend toward significance (placebo 310 vs. TNK 220 ng/ml, P = 0.051). Acute pulmonary embolism causes marked but transient inflammation, as demonstrated by the significant elevation in the inflammatory biomarkers at diagnosis, followed by their reduction in more than 80% of patients at 3-month follow-up.
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