Detection of hypofibrinolysis in stable coronary artery disease using the overall haemostatic potential assay

• Published in: Thrombosis research Vol. 131; no. 5; pp. 457 - 462
• Main Authors: Reddel, Caroline J, Curnow, Jennifer L, Voitl, Jasmin, Rosenov, Alexander, Pennings, Gabrielle J, Morel-Kopp, Marie-Christine, Brieger, David B
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.05.2013
• Subjects: Aged; Aged, 80 and over; Blood Coagulation - physiology; Coronary artery disease; Coronary Artery Disease - blood; Female; fibrinolysis; Fibrinolysis - physiology; Hematology, Oncology and Palliative Medicine; Hemostasis; Humans; Male; Middle Aged; overall haemostatic potential; Thrombin - metabolism; thrombin generation; coronary artery disease; CRP; C-reactive protein; rtPA; myocardial infarction; CLT; fibrinolysis; acute coronary syndrome; OD; OHP; TAFI; OFP; PAI-1; MI; overall coagulation potential; overall haemostatic potential; recombinant tissue plasminogen activator; CAD; thrombin activatable fibrinolysis inhibitor; ACS; plasminogen activator inhibitor-1; CAT; Calibrated Automated Thrombogram; thrombin generation; OCP; optical density; overall fibrinolytic potential; clot lysis time; Coronary artery disease
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2013.03.015

Abstract Introduction Patients with stable coronary artery disease (CAD) are at risk of arterial thrombosis causing myocardial infarction. Detection of global haemostatic markers of hypercoagulability and hypofibrinolysis may be important for risk stratification and individualised treatment. We examined overall haemostatic potential (OHP) and thrombin generation in a group of stable CAD patients. We also sought to investigate associations between fibrinolytic inhibitors and abnormal global fibrinolysis in these patients. Materials and Methods Blood samples were collected from 56 patients defined by coronary anatomy as symptomatically stable CAD. Medications were recorded. Samples were analysed using the global coagulation assays OHP and thrombin generation (calibrated automated thrombogram, CAT), platelet aggregometry measured by Multiplate®, and levels of plasminogen activator inhibitor-1 (PAI-1) antigen measured by ELISA. Results were compared with a reference group of healthy controls. Results Stable CAD patients displayed increased fibrin and thrombin generation and impaired fibrinolysis (decreased overall fibrinolytic potential, OFP, and increased clot lysis time) compared with healthy controls. No effect of antiplatelet agents or other medications on these parameters was observed using platelet-poor plasma. After multivariate adjustment, OFP of healthy individuals was significantly associated with fibrinogen, but in CAD patients PAI-1 became an important determinant. Conclusions Hypercoagulability of plasma is observed in stable CAD, with both increased thrombin generation and reduced fibrinolytic potential making a significant contribution. The OHP assay may provide a simple method of identifying hypercoagulability in individual patients.