Arteriosclerosis, thrombosis, and vascular biology · 2009
Altered plasma fibrin clot properties are associated with in-stent thrombosis.
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Undas Anetta, Zalewski Jaroslaw, Krochin Marek, Siudak Zbigniew, Sadowski Marcin, Pregowski Jerzy, Dudek Dariusz, Janion Marianna, Witkowski Adam, Zmudka Krzysztof
Аннотация
OBJECTIVE: We sought to investigate whether patients with in-stent thrombosis (IST) display altered plasma fibrin clot properties.
METHODS AND RESULTS: We studied 47 definite IST patients, including 15 with acute, 26 subacute and 6 late IST, and 48 controls matched for demographics, cardiovascular risk factors, concomitant treatment and angiographic/stent parameters. Plasma clot permeability (K(s)), which indicates a pore size, turbidity (lag phase, indicating the rate of fibrin clot formation, DeltaAbs(max), maximum absorbance of a fibrin gel, reflecting the fiber thickness), lysis time (t(50%)) and maximum rate of D-dimer release from clots (D-D(rate)) were determined 2 to 73 (median 14.7) months after IST. Patients with IST had 21% lower K(s), 14% higher DeltaAbs(max), 11% lower D-D(rate), 30% longer t(50%) (all P<0.0001) and 5% shorter lag phase compared to controls (P=0.042). There were no correlations between clot variables and the time of IST or that from IST to blood sampling. Multiple regression analysis showed that K(s) (odds ratio=0.36 per 0.1 microm(2), P<0.001), D-D(rate) (odds ratio=0.16 per 0.01 mg/L/min, P<0.001) and stent length (odds ratio=1.1 per 1 mm, P=0.043) were independent predictors of IST (R(2)=0.58, P<0.001).
CONCLUSIONS: IST patients tend to form dense fibrin clots resistant to lysis, and altered plasma fibrin clot features might contribute to the occurrence of IST.
METHODS AND RESULTS: We studied 47 definite IST patients, including 15 with acute, 26 subacute and 6 late IST, and 48 controls matched for demographics, cardiovascular risk factors, concomitant treatment and angiographic/stent parameters. Plasma clot permeability (K(s)), which indicates a pore size, turbidity (lag phase, indicating the rate of fibrin clot formation, DeltaAbs(max), maximum absorbance of a fibrin gel, reflecting the fiber thickness), lysis time (t(50%)) and maximum rate of D-dimer release from clots (D-D(rate)) were determined 2 to 73 (median 14.7) months after IST. Patients with IST had 21% lower K(s), 14% higher DeltaAbs(max), 11% lower D-D(rate), 30% longer t(50%) (all P<0.0001) and 5% shorter lag phase compared to controls (P=0.042). There were no correlations between clot variables and the time of IST or that from IST to blood sampling. Multiple regression analysis showed that K(s) (odds ratio=0.36 per 0.1 microm(2), P<0.001), D-D(rate) (odds ratio=0.16 per 0.01 mg/L/min, P<0.001) and stent length (odds ratio=1.1 per 1 mm, P=0.043) were independent predictors of IST (R(2)=0.58, P<0.001).
CONCLUSIONS: IST patients tend to form dense fibrin clots resistant to lysis, and altered plasma fibrin clot features might contribute to the occurrence of IST.
Предметные рубрики MeSH
Acute DiseaseAgedAngioplasty, Balloon, CoronaryCase-Control StudiesCoronary AngiographyFemaleFibrinFibrin Fibrinogen Degradation ProductsFibrinolysisHumansKineticsLogistic ModelsMaleMiddle AgedNephelometry and TurbidimetryOdds RatioPermeabilityPlatelet Aggregation InhibitorsProsthesis DesignRetrospective StudiesRisk AssessmentRisk FactorsStentsThrombosisTreatment Outcome