A prothrombotic state and denser clot formation in patients following acute limb ischemia of unknown cause. Issue 187 (March 2020)

• Record Type: Journal Article
• Authors: Karpińska, Izabela A.; Nowakowski, Tomasz; Wypasek, Ewa; Plens, Krzysztof; Undas, Anetta
• Is Part Of: Thrombosis research. Issue 187(2020)
• Page Start: 32
• Page End: 38
• Publication Date: 2020-03
• Subjects: α2AP α2-antiplasmin -- ABI ankle-brachial index -- Abmax maximum absorbance -- ACE inhibitors angiotensin-converting enzyme inhibitors -- ALI acute limb ischemia -- APTT activated partial thromboplastin time -- ASA acetylsalicylic acid -- AT atrial fibrillation -- AT antithrombin -- CAD coronary artery disease -- CLI critical limb ischemia -- CLT clot lysis time -- CRP C-reactive protein -- CT computer tomography -- D–Dmax maximum D-dimer concentrations -- D–Drate maximum rate of increase in D-dimer levels -- ETP endogenous thrombin potential -- F factor -- HDL high-density lipoprotein -- INR International Normalized Ratio -- Ks permeation coefficient -- LAC lupus anticoagulant -- LDL low-density lipoprotein -- LVT left ventricular thrombus -- MI myocardial infraction -- MRI magnetic resonance imaging -- PAD peripheral arterial disease -- PAI-1 plasminogen activator inhibitor-1 antigen -- PC protein C -- PS protein S -- rtPA recombinant tissue plasminogen activator -- TAFIa/ia thrombin activatable fibrinolysis inhibitor antigen -- TC total cholesterol -- TF tissue factor -- TG triglycerides -- VTE venous thromboembolism; Prothrombotic state -- Fibrin clot properties -- Acute limb ischemia -- Hypofibrinolysis; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.01.008
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Fibrin clot structure differs between healthy individuals and those following thromboembolic events. Dense and poorly lysable fibrin clots have also been reported in peripheral artery disease. We studied fibrin clot properties and its determinants in individuals with a history of acute lower limb ischemia (ALI) of unknown cause. Materials and methods: In this case-control study, we enrolled 43 patients who experienced ALI of unknown cause, and two age-and sex-matched reference groups: (1) patients with cryptogenic non-lacunar stroke ( n = 43) and (2) individuals without any history of thromboembolism (n = 43, control group). Plasma fibrin clot properties, along with thrombin generation and fibrinolysis markers were assessed following ≥3 months of anticoagulation. Results: Compared with the control group, the ALI group exhibited more compact plasma fibrin clots (13.4% lower permeability [Ks ], p = .001), decreased formed clot lysis (12.5% lower D-Drate, p = .001) and unaltered clot lysis potential, along with enhanced thrombin generation potential (49% higher peak thrombin concentration, p < .0001). There were no differences in these variables between ALI and stroke patients. Patients with ALI had slightly higher α2 -antiplasmin and lower plasminogen activator inhibitor 1 levels compared with the stroke and control groups (all p < .01). Conclusions: Patients who experienced ALI of unknown cause display a prothrombotic fibrin clot phenotype, including increased clot density and hypofibrinolysis associated with higher thrombin generation, which might suggest potential benefits from prolonged anticoagulation in this disease. Highlights: Prothrombotic fibrin clot structure is documented in patients with venous and arterial thromboembolic diseases Compact fibrin clot formation and hypofibrinolysis characterizes patients after acute limb ischemia (ALI) of unknown cause Altered clot properties in patients after ALI of unknown cause are similar to those after cryptogenic non-lacunar stroke Patients following ALI of unknown cause might benefit from prolonged anticoagulant therapy