Oral Presentation No. 41 High plasma von Willebrand factor concentration is associated with the development of bleeding complications in patients with polyvascular disease receiving multicomponent antithrombotic therapy

Background

von Willebrand factor (VWF) is well known biochemical marker of endothelial dysfunction that increased may be associated with the development of thrombotic complications in patients with polyvascular disease (PD). We aimed to asses the relation of VWF to the development of bleeding outcomes in patients with PD receiving multicomponent antithrombotic therapy (MAT).

Material and methods

The data were obtained during the prospective register REGATA-1, NCT04347200. 95 patients (70 males), median age 67 [IQR 61; 72] with PD (coronary artery disease and peripheral atherosclerosis of at least one vascular territory ≥ 50%) were enrolled. 61% of patients received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid, other (39%)with clopidogrel. Median follow-up was 10 months [IQR 8.0; 12.0]. The safety end point was major and clinically relevant bleedings (type 2–5) according to the BARC classification. Plasma samples for VWF were taken at the inclusion and analyzed using ELISA.

Results

Frequency of BARC 2–5 bleedings was 20%. The most frequent (79%) was gastrointestinal bleedings. Median VWF plasma concentration was 154% [116; 196]. According to the quartile analysis, VWF values in the top three quartiles distribution (cut-off value > 122%) were associated with a higher frequency of bleeding events: 3.7% versus 36.7%, OR 8.8; CI 1,11-69,9, ? = 0.0392. Bleeding-free survival in groups formed depending on the VFW plasma concentration (122 > and ≤ 122%) was 96.2% vs. 73.9%, respectively, Log-Rank P = 0.0488.

Conclusions

Increase of VWF plasma concentration (> 122%) is associated with the development of major and clinically relevant bleedings in patients with PD receiving MAT.

The monomeric C-reactive protein level is associated with the increase in carotid plaque number in patients with subclinical carotid atherosclerosis

The high-sensitivity C-reactive protein (hsCRP) assay measures the level of the pentameric form of CRP in blood. Currently, there are no available assays measuring the level of the monomeric form of CRP (mCRP), produced at sites of local inflammation. We developed an assay measuring the mCRP level in blood plasma with functional beads for flow cytometry. The assay was used to measure the mCRP level in 80 middle-aged individuals with initially moderate cardiovascular SCORE risk. By the time of the mCRP measurement, the patients have been followed up for subclinical carotid atherosclerosis progression for 7 years. Ultrasound markers of subclinical atherosclerosis, which included plaque number (PN) and total plaque height (PH), were measured at baseline and at the 7th-year follow-up survey. Inflammatory biomarkers, including mCRP, hsCRP, inteleukin-6 (IL-6) and von Willebrand factor (VWF) level, were measured at the 7th-year follow-up survey. The median level of mCRP was 5.2 (3.3; 7.1) μg/L, hsCRP 1.05 (0.7; 2.1) mg/L, IL-6 0.0 (0.0; 2.8) pg/mL, VWF 106 (77; 151) IU/dL. In the patients with the mCRP level below median vs. the patients with the median mCRP level or higher, change from baseline in PN was 0.0 (0.0; 1.0) vs. 1.0 (1.0; 2.0) and PH 0.22 (−0.24; 1.91) mm vs. 1.97 (1.14; 3.14) mm, respectively (p < 0.05). The adjusted odds ratio for the formation of new carotid atherosclerotic plaques was 4.7 (95% CI 1.7; 13.2) for the patients with the median mCRP level or higher. The higher mCRP level is associated with the more pronounced increase in PN and PH in patients with normal level of traditional inflammatory biomarkers and initially moderate cardiovascular SCORE risk.