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Wang X, Zhao J, Zhang Y, Xue X, Yin J, Liao L, Xu C, Hou Y, Yan S, Liu J. Kinetics of plasma von Willebrand factor in acute myocardial infarction patients: a meta-analysis. Oncotarget 2017; 8:90371-90379. [PMID: 29163836 PMCID: PMC5685757 DOI: 10.18632/oncotarget.20091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Previous studies have shown a variation in plasma level of von Willebrand factor (vWF) in acute myocardial infarction (AMI) patients but with contentious results. In this study, we performed a meta-analysis to evaluate the kinetics of plasma vWF after AMI. A total of 11 qualified studies were obtained through systematical search in PubMed, Web of science, Cochrane Library database and CNKI, followed by search of reference lists, involving 519 AMI patients and 466 non-AMI controls. The standard mean difference (SMD) and 95% confidence intervals (95% CI) were calculated using random-effects model. Results indicated that the plasma vWF was significantly increased in the first several hours after onset of AMI (SMD = 1.94, 95% CI = 1.39-2.48, P < 0.001) and stayed at high level until 24 h (SMD = 1.17, 95% CI = 0.45-1.89, P = 0.001). Elevated level of vWF appeared to persist for one week and reduced to normal until the fourteenth day after AMI (SMD = 0.44, 95% CI = -0.14-1.02, P = 0.14). Subgroup analysis revealed that the high level of vWF lasted just for 1 day in patients with a symptom duration ≤ 6 h before admission. For patients with a symptom duration > 6 h, elevated vWF was found in all 7 days except day 1. Our findings determined the kinetics of plasma vWF after AMI, and might provide a new insight in monitoring AMI progression.
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Affiliation(s)
- Xia Wang
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Junyu Zhao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Yong Zhang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Xiujuan Xue
- Department of Nursing, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Jie Yin
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Lin Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Cuiping Xu
- Department of Nursing, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Suhua Yan
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
| | - Ju Liu
- Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 Shandong, China
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Heper G, Murat SN, Durmaz T, Kalkan F. Prospective Evaluation of von Willebrand Factor Release After Multiple and Single Stenting. Angiology 2016; 55:177-86. [PMID: 15026873 DOI: 10.1177/000331970405500210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The hypothesis that von Willebrand factor (vWf) release after multiple coronary stenting may be higher than release after single coronary stenting was tested. Preliminary data suggest that multiple stenting is a predictor of thrombosis, and vWf levels in the coronary sinus reflect coronary endothelial injury. Therefore vWf as an indicator of thrombogenesis and endothelial injury was studied. vWf levels were obtained in the coronary sinus at the prestenting and poststenting period in 50 patients with ischemic heart disease who underwent elective coronary stenting (25 patients in single stent group and 25 patients in multiple stent group). Eight subjects who underwent diagnostic coronary angiography were used as controls. vWf levels increased significantly after multiple stenting and vWf levels were significantly different from vWf levels after single stenting. In single stent group, vWf levels in type C lesions were significantly different from levels detected in type A and B lesions. Multiple coronary stenting induces a rapid increase in vWf expression in the coronary circulation. These changes may contribute to the pathogenesis of acute or subacute stent thrombosis and restenosis after multiple stenting.
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Affiliation(s)
- Gulumser Heper
- Department of Cardiology, SSK Ihtisas Hospital, Ankara, Turkey.
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3
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The effect of preoperative aspirin administration on postoperative level of von Willebrand factor in off-pump coronary artery bypass surgery. Heart Vessels 2009; 24:169-74. [DOI: 10.1007/s00380-008-1105-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 08/08/2008] [Indexed: 10/20/2022]
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Spiel AO, Gilbert JC, Jilma B. von Willebrand factor in cardiovascular disease: focus on acute coronary syndromes. Circulation 2008; 117:1449-59. [PMID: 18347221 DOI: 10.1161/circulationaha.107.722827] [Citation(s) in RCA: 283] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
von Willebrand factor (VWF) plays a pivotal role in platelet adhesion and aggregation at sites of high shear rates (eg, in coronary arteries that have stenotic or ruptured atherosclerotic plaque lesions). Numerous studies have investigated the relationship between VWF plasma levels and thromboembolic cardiovascular events. In contrast to the rather weak association in the general population, in patients with preexisting vascular disease, VWF is significantly predictive for adverse cardiac events, including death. Likewise, VWF typically rises during the course of acute coronary syndrome, and the extent of this VWF release is an independent predictor of adverse clinical outcome in these patients. Various lines of evidence indicate that VWF is not only a marker but also actually an important effector in the pathogenesis of myocardial infarction. This central role of VWF in thrombogenesis has made it a promising target for research into new antiplatelet therapies that specifically inhibit VWF. This review focuses on the role of VWF in acute coronary syndrome and further outlines the relevance of therapeutic interventions targeting VWF for acute coronary syndrome patients.
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Affiliation(s)
- Alexander O Spiel
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Ray KK, Morrow DA, Gibson CM, Murphy S, Antman EM, Braunwald E. Predictors of the rise in vWF after ST elevation myocardial infarction: implications for treatment strategies and clinical outcome. Eur Heart J 2005; 26:440-6. [PMID: 15673542 DOI: 10.1093/eurheartj/ehi104] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Prior studies suggest that acute coronary syndromes (ACSs) are associated with endothelial activation and that this is of prognostic significance. We hypothesized that endothelial activation, as measured by a rise in von Willebrand Factor (DeltavWF), was influenced by the thrombolysis in myocardial infarction flow grade (TFG), the corrected TIMI frame count (CTFC) and the choice of anticoagulant therapy after fibrinolysis in ST elevation myocardial infarction (STEMI). METHODS AND RESULTS Data were drawn from the enoxaparin and tenecteplase tissue plasminogen activator (TNK-tpa) with or without GPIIb/IIIa inhibitor as the reperfusion strategy in the STEMI trial (ENTIRE-TIMI 23). Three hundred and fourteen patients had serial measurements of vWF (baseline and 48-72 h) and angiographic data available. TFG<3 (P=0.0042) or CTFC>/=40 at 60 min (P=0.0035) were associated with a higher DeltavWF. DeltavWF >/=75th percentile was associated with a higher incidence of death or myocardial infarction (MI) at 30 days, compared with <75th percentile (11.2 vs. 4.1%, P=0.027). Enoxaparin independently reduced the DeltavWF (P=0.019) and also the composite of death or MI (OR 0.33, 95% CI 0.12-0.91, P=0.03) compared with unfractionated heparin. CONCLUSION In STEMI treated by fibrinolysis, coronary flow at 60 min and choice of adjunctive anticoagulant appear to be independent determinants of DeltavWF. Enoxaparin is independently associated with a reduction in DeltavWF and a reduction in death or MI. The clinical benefits of enoxaparin as an adjunctive treatment in STEMI may be mediated in part by a reduction in vWF release.
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Affiliation(s)
- Kausik K Ray
- TIMI Study Group and Cardiovascular Division, Department of Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA.
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Frossard M, Fuchs I, Leitner JM, Hsieh K, Vlcek M, Losert H, Domanovits H, Schreiber W, Laggner AN, Jilma B. Platelet function predicts myocardial damage in patients with acute myocardial infarction. Circulation 2004; 110:1392-7. [PMID: 15313953 DOI: 10.1161/01.cir.0000141575.92958.9c] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Platelet activation is a hallmark of acute coronary syndromes. Numerous lines of evidence suggest a mechanistic link between von Willebrand factor or platelet hyperfunction and myocardial damage in patients with acute coronary syndromes. Thus, we assessed whether platelet function under high shear rates (collagen adenosine diphosphate closure times [CADP-CTs]) measured with the platelet function analyzer (PFA-100) may be enhanced in patients with myocardial infarction (MI) and whether it may predict the extent of myocardial damage as measured by creatine kinase (CK-MB) or troponin T (TnT) levels. METHODS AND RESULTS Patients with acute chest pain or symptoms suggestive of acute coronary syndromes (n=216) were prospectively examined at an emergency department. CADP-CT was significantly shorter in patients with MI, particularly in those with an ST-segment-elevation MI (STEMI) compared with the other patient groups (unstable angina, stable coronary artery disease, or controls). Furthermore, CADP-CT and collagen epinephrine-CT at presentation were independent predictors of myocardial damage as measured by CK-MB or TnT. Patients with MI whose CADP-CT values fell in the first quartile had 3-fold higher CK-MB and TnT levels than those in the fourth quartile. CONCLUSIONS Patients with STEMI have significantly enhanced platelet function when measured under high shear rates. CADP-CT is an independent predictor of the severity of MI, as measured by markers of cardiac necrosis. Measurement of platelet function with the PFA-100 may help in the risk stratification of patients presenting with MI.
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Affiliation(s)
- Martin Frossard
- Department of Clinical Pharmacology, Medical University, Vienna, Austria
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Heper G, Bayraktaroğlu M. The importance of von Willebrand factor level and heart rate changes in acute coronary syndromes: a comparison with chronic ischemic conditions. Angiology 2003; 54:287-99. [PMID: 12785021 DOI: 10.1177/000331970305400304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pathogenesis of acute coronary syndrome (ACS) and transient myocardial ischemia (TMI) is not completely understood. Therefore, the authors studied the biological indicators of thrombogenesis and sympathetic activity. The study was conducted on 50 patients with acute coronary syndrome and 30 patients with stable angina pectoris. Treatment was standardized with low-molecular-weight heparin and 300 mg aspirin/day but with no IIb/IIIa inhibitors, an oral beta-blocker, diltiazem 60 mg tid, glyceryl trinitrate i.v. in patients with ACS but with mononitrates orally and low-molecular-weight heparin in patients with stable angina. Twenty-four-hour continuous ECG monitoring and ST segment analysis were performed on day 2 of admission and heart rate analysis was performed 10, 5, and 1 minute before and during the myocardial ischemia periods. Blood sampling for von Willebrand factor (vWf) determination was performed through a peripheral vein at 8 AM, noon, 6 PM and 10 PM and half an hour after the description of angina. The patients with ACS were grouped as transient myocardial ischemia positive (n = 20) and negative (n = 30). The patients with stable angina were designated as the control group (n = 30). The detected vWf levels at 4 different daytime periods in patients with ACS were significantly higher than those in patients with stable angina. At the 6 PM to 10 PM period, the vWf level increase was significantly higher in patients with TMI than in the patients without TMI. At the 8 AM to noon period, the detected vWf levels decreased significantly in both TMI groups. During the nocturnal ischemia periods, the increase in vWf levels immediately after angina was significantly more apparent than the detected changes during daytime ischemia. Analysis showed that heart rates before the ischemia during stable angina episodes were significantly higher than those in TMI (-) (silent) angina. The heart rate difference between 10 minutes before and during the ischemia in the angina group was significantly different from that during TMI (-) (silent) ischemia. The heart rates at the times related to ischemia in the nocturnal period were significantly lower than those in the daytime period. The heart rate differences between the ischemia-related times and during the ischemia were significantly higher in daytime ischemic attacks than in nocturnal ischemic attacks. The study confirms that the vWf level, which is an indicator of thrombogenesis, was significantly increased in patients with ACS. Nocturnal ischemia is associated with thrombogenesis. Daytime ischemia is associated with increased sympathetic activity, and symptomatic ischemia is usually associated with increased sympathetic activity.
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Affiliation(s)
- Gülümser Heper
- Department of Cardiology, SSK Ihtisas Hospital, Ankara, Turkey.
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Figueras J, Monasterio Y, Lidón RM, Nieto E, Soler-Soler J. Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest. J Am Coll Cardiol 2000; 36:2036-43. [PMID: 11127437 DOI: 10.1016/s0735-1097(00)01023-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The goal of this study was to investigate possible differences in thrombin generation or fibrinolytic capacity in patients with unstable angina (UA) or acute myocardial infarction (AMI) with or without recurrent angina at rest. BACKGROUND Angina at rest in patients with AMI or UA is generally produced by a reduction in coronary flow, but it is unclear whether patients with or without this event differ in their thrombin generation or in their fibrinolytic capacities, which might influence the course of the culprit lesion. METHODS Thrombin-antithrombin complex (TAT), D-dimer, fibrinogen and plasminogen activator inhibitor (PAI-1) antigen plasma levels were determined in 40 patients with AMI and in 23 with UA on admission, at 10 days and at three months. RESULTS First day values for TAT, fibrinogen and D-dimer were comparable in patients with AMI and in those with UA. At 10 days they increased significantly in each group, and at 3 months they decreased to a similar extent. First day PAI-1 levels, however, were highest in both groups and declined in AMI patients at 10 days and at three months, whereas they also decreased at 10 days in UA patients but not any further at three months. Ten patients with AMI (25%) and 12 with UA (52%) developed in-hospital angina at rest. First day values for TAT, fibrinogen and D-dimer were similar in patients with or without angina, but PAI-1 levels were higher in the former subset (p < 0.008). At 10 days, however, TAT (p < 0.013) and D-dimer (p < 0.013) were higher in patients who developed angina than in those who did not. CONCLUSIONS The higher inhibition of fibrinolytic activity in the first day in patients with AMI or UA who will develop recurrent angina suggests that maintenance of a prothrombotic status may contribute to its mechanisms, perhaps by preventing passivation of the culprit thrombus/plaque. This is consistent with greater thrombin generation and greater levels of fibrynolitic products at 10 days observed in these patients compared with those who attain early stability.
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Affiliation(s)
- J Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, Barcelona, Spain.
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9
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Abstract
Since its discovery, nearly 90 years, heparin has been used successfully for the treatment of thromboembolic processes. However, therapy with heparin has several important limitations. Most importantly, the poor predictability of its anticoagulant effects has led to the development of the low molecular weight heparins (LMWHs), which are derived from unfractionated heparin and appear to have pharmacologic advantages, require no laboratory monitoring and are more predictable than their parent compounds. LMWHs have been used for several years in the treatment of venous thromboembolic disorders. More recently, the LMWHs have been used to treat patients with acute coronary interventions. As the results of new studies are revealed, we will learn whether the use LMWH can be extended to all disorders where unfractionated heparin is currently the standard therapy.
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Affiliation(s)
- O M Aguilar
- Baylor College of Medicine, Houston, Texas 77030, USA
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10
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Paczuski R, Bialkowska A, Kotschy M, Burduk D, Betlejewski S. Von Willebrand factor in plasma of patients with advanced stages of larynx cancer. Thromb Res 1999; 95:197-200. [PMID: 10498389 DOI: 10.1016/s0049-3848(99)00041-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- R Paczuski
- Department of Pathophysiology, The Ludwik Rydygier Medical University in Bydgoszcz, Poland.
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Montalescot G, Philippe F, Ankri A, Vicaut E, Bearez E, Poulard JE, Carrie D, Flammang D, Dutoit A, Carayon A, Jardel C, Chevrot M, Bastard JP, Bigonzi F, Thomas D. Early increase of von Willebrand factor predicts adverse outcome in unstable coronary artery disease: beneficial effects of enoxaparin. French Investigators of the ESSENCE Trial. Circulation 1998; 98:294-9. [PMID: 9711933 DOI: 10.1161/01.cir.98.4.294] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pathogenesis of unstable angina and non-Q-wave myocardial infarction is still poorly understood, and early evaluation of prognosis remains difficult. We therefore studied the predictive value of 5 biological indicators of inflammation, thrombogenesis, vasoconstriction, and myocardial necrosis, and we examined the effects of enoxaparin and unfractionated heparin on these markers after 48 hours of treatment. METHODS AND RESULTS Sixty-eight patients with unstable angina or non-Q-wave myocardial infarction randomized in the international ESSENCE trial participated in this French substudy. C-reactive protein, fibrinogen, von Willebrand factor antigen, endothelin-1 and troponin I were measured on admission and 48 hours later. The composite end point of death, myocardial infarction, recurrent angina, or revascularization was significantly lower at 14 and 30 days of follow-up in patients allocated to enoxaparin compared with unfractionated heparin. All acute-phase reactant proteins were elevated on admission and increased further at 48 hours. Multivariate analysis demonstrated that the rise of von Willebrand factor over 48 hours was a significant and independent predictor of the composite end point at both 14 days and 30 days. Moreover the early increase of von Willebrand factor was more frequent and more severe with unfractionated heparin than with enoxaparin (mean change was +8.7+/-8.8% with enoxaparin versus +93.9+/-11.7% with unfractionated heparin, P<0.0001). The other clinical and biological variables did not predict outcome. CONCLUSIONS In patients with unstable angina or non-Q-wave myocardial infarction, the acute-phase proteins increase over the first 2 days despite medical treatment. The early rise of von Willebrand factor is an independent predictor of adverse clinical outcome at 14 days and at 30 days. Enoxaparin provides protection as evidenced by the reduced release of von Willebrand factor, which represents a favorable prognostic finding.
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Affiliation(s)
- G Montalescot
- Department of Cardiology, Pitié-Salpétrière Hospital, Paris, France.
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Tousoulis D, Davies G, Tentolouris C, Bosinakou E, Toutouzas P. Relation of von Willebrand factor to occurrence of Q waves and thrombolytic treatment in acute myocardial infarction. Am J Cardiol 1998; 81:497-500. [PMID: 9485144 DOI: 10.1016/s0002-9149(97)00953-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We measured the changes of plasma von Willebrand factor antigen and fibrinogen levels in patients with acute myocardial infarction treated with recombinant tissue plasminogen activator and patients not given fibrinolytic drugs. The von Willebrand factor levels are greater in patients with Q-wave than in patients with non-Q-wave myocardial infarction and are independent of thrombolytic treatment. Fibrinogen levels are depressed by thrombolytic treatment but are unrelated to the presence or absence of Q waves.
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Affiliation(s)
- D Tousoulis
- Cardiology Unit, Hippokration Hospital, Athens University Medical School, Greece
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Philipp CS, Cisar LA, Kim HC, Wilson AC, Saidi P, Kostis JB. Association of hemostatic factors with peripheral vascular disease. Am Heart J 1997; 134:978-84. [PMID: 9398113 DOI: 10.1016/s0002-8703(97)80024-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hemostatic risk factors have been well established in coronary artery disease but less well studied in peripheral vascular disease. The relationship of coagulation and fibrinolytic proteins to lower limb arterial occlusive disease and other vascular risk factors remains poorly defined. Fibrinogen, factor VII coagulant activity, von Willebrand factor (vWf) antigen, and plasminogen activator inhibitor-1 (PAI-1) activity were measured in 46 adult participants in the Arterial Disease Multiple Intervention Trial (ADMIT) and in 76 control subjects and related to ankle-brachial systolic pressure index (ABI), a measure of lower limb arterial stenosis. The primary inclusion criterion for the ADMIT study population was an average of two ABIs <0.85. Fibrinogen and PAI-1 in ADMIT subjects were significantly higher than in control subjects (331 +/- 52 mg/dl vs 273 +/- 46 mg/dl, p < 0.0001; 18.7 +/- 10 units/ml vs 13.5 +/- 8.9 units/ml, p < 0.04). There were significant correlations of fibrinogen with ABI, factor VII coagulant activity, and systolic and diastolic blood pressures; PAI-1 with body mass index and age; and factor VII coagulant activity with cholesterol levels. Logistic regression analysis, considering hemostatic variables and several known nonhemostatic risk factors of peripheral arterial disease, showed that fibrinogen and systolic blood pressure were independently associated with ABI status in this population. The results demonstrate a strong independent correlation between fibrinogen levels and the presence of lower limb arterial stenosis. PAI-1 levels were elevated in ADMIT participants, but multivariate analysis did not demonstrate an independent relationship between PAI-1 and ABI.
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Affiliation(s)
- C S Philipp
- Division of Hematology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08904, USA.
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Tousoulis D, Bosinakou E, Tentolouris C, Apostolopoulos T, Copshari C, Kyriakides M, Toutouzas P. t-Plasminogen activator and von Willebrand factor in patients with unstable angina. Int J Cardiol 1996; 54:89-92. [PMID: 8792192 DOI: 10.1016/0167-5273(96)02600-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We investigated whether the clinical evolution of symptoms in patients admitted with unstable angina is associated with changes in t-plasminogen activator antigen (t-PA) and von Willebrand (vW) factor levels. Concentrations of vW factor antigen and t-PA antigen were measured by an enzyme-linked immunoassay method in 10 patients who became clinically stable within 24 h of admission and remained so for 5 days. A significant rise in morning t-PA plasma level occurred 24 h after the admission (15.15 +/- 2.1 ng/ml, P < 0.05), whereas the vW factor remained unchanged. No significant changes were found in the night concentration in t-PA and vW factor during the 5 day period. Thus t-PA level is significantly raised 24 h after admission in patients with unstable angina who stabilize in response to medical treatment.
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Affiliation(s)
- D Tousoulis
- Cardiology Unit, Hippokration Hospital, Athens University Medical School, Greece
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16
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Montalescot G, Ankri A, Vicaut E, Drobinski G, Grosgogeat Y, Thomas D. Fibrinogen after coronary angioplasty as a risk factor for restenosis. Circulation 1995; 92:31-8. [PMID: 7788913 DOI: 10.1161/01.cir.92.1.31] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Fibrinogen is a risk factor for cardiovascular disease and is related to the severity of coronary atherosclerosis. Its role in restenosis after coronary angioplasty remains unknown. Although platelets and thrombosis contribute to the pathogenesis of restenosis, few clinical data are available concerning the relations between restenosis and proteins of the coagulation and fibrinolytic systems. METHODS AND RESULTS In 107 consecutive patients undergoing coronary angioplasty, we measured plasma levels of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor, and fibrinogen before and immediately after angioplasty and at a 6-month follow-up. The individual changes of intraluminal diameter were measured by quantitative coronary angiography, and patients were classified according to four definitions of restenosis: (1) a final stenosis > 50%, (2) a loss of minimal luminal diameter during the follow-up period greater than the measurement variability in our laboratory (> 0.52 mm), (3) a loss of at least 50% of the gain in luminal diameter achieved by angioplasty, and (4) the combination of definitions 1 and 2. The relations between coagulation variables and each definition of restenosis were assessed univariately; then with the clinical variables included, the relations were analyzed multivariately. Angiographic follow-up was obtained in 92% of patients with a primary success of angioplasty. Global restenosis rates were 38%, 43%, 48%, and 30% for definitions 1 through 4, respectively. Plasma levels of t-PA antigen and PAI-1 antigen were not associated with any of the four definitions of restenosis. Multivariate analysis demonstrated that von Willebrand factor measured immediately after angioplasty predicted restenosis according to definitions 2 and 3. Fibrinogen measured within 6 months of follow-up was significantly increased in all restenosis groups of the four definitions. Patients with a fibrinogen concentration > 3.5 g/L at follow-up had higher restenosis rates than patients with a concentration < 3.5 g/L: 55% versus 22% (P = .001), 68% versus 31% (P = .002), 63% versus 37% (P = .01), and 74% versus 26% (P = .002) for definitions 1 through 4, respectively. The loss index was lower (P = .003) and the net gain higher (P = .03) in patients with a fibrinogen level < 3.5 g/L. There was a significant correlation between fibrinogen level and angiographic loss index (r = .41; P < .0001). Multivariate analysis confirmed that the fibrinogen level predicted restenosis with all definitions. CONCLUSIONS An independent relation exists between von Willebrand factor measured immediately after angioplasty and restenosis defined by the degree of intraluminal renarrowing. An elevated fibrinogen level during follow-up is a strong biochemical predictor of restenosis. Therefore, fibrinogen should be considered at least as an independent marker of restenosis and perhaps as a common risk factor for both spontaneous coronary atherosclerosis and postangioplasty restenosis, which is an accelerated form of atherosclerosis.
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Affiliation(s)
- G Montalescot
- Department of Cardiology, Centre Hospitalier Universitaire Pitié-Salpétrière, Paris, France
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17
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al-Nozha M, Gader AM, al-Momen AK, Noah MS, Jawaid M, Arafa M. Haemostatic variables in patients with unstable angina. Int J Cardiol 1994; 43:269-77. [PMID: 8181885 DOI: 10.1016/0167-5273(94)90207-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To assess the contribution of thrombus formation in the pathogenesis of unstable angina, we employed the recently developed assays of small fragments which reflect the degree of activation of various components of the haemostatic system. Such haemostatic measurements were undertaken in patients with unstable angina (n = 47) from the time of their admission to the coronary care unit (CCU) at 8-h intervals in the first 24 h and then daily for a total of 5 days. The results obtained were compared with healthy control values. Patients exhibited lower ATIII, prolongation of the APTT and TT, but not PT or the reptilase time, which is a consequence of heparinization. There was significant elevation of fibrinogen, factor VIII:C, von Willebrand factor:antigen and von Willebrand factor:ristocetin cofactor throughout the study period. There was also evidence of thrombin generation as indicated by the elevated levels of fibrinopeptide A (FPA) and thrombin-antithrombin complexes. The platelet release proteins, beta-thromboglobulin (BTG) and platelet factor 4 (PF4), were markedly elevated in the first 2 days and dropped gradually thereafter. The fibrinolytic inhibitor, plasminogen activator inhibitor (PAI), levels were elevated throughout. Proteins C and S, plasminogen and alpha 2-antiplasmin remained unchanged. It was concluded that in patients with unstable angina, there is significant activation of the clotting system and inhibition of fibrinolysis which confirms the existence of a tendency towards thrombus formation in patients with unstable angina.
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Affiliation(s)
- M al-Nozha
- Department of Medicine, College of Medicine, Riyadh, Saudi Arabia
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18
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Norris RM, Ockelford PA, Cross DB, Rivers JT, Smith JM, Takayama M, White HD. Reduced synthesis of tissue plasminogen activator by vascular endothelium during acute myocardial infarction. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1992; 22:261-4. [PMID: 1497553 DOI: 10.1111/j.1445-5994.1992.tb02122.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We measured levels of tissue plasminogen activator (t-PA) antigen in 100 patients within six hours of the onset of acute myocardial infarction, in 34 patients with chronic angina but no recent infarction, and in 36 normal subjects. We also assayed von Willebrand factor in the acute patients and in the normal subjects. Measurements were repeated in 40 acute patients at three weeks after myocardial infarction. Although resting levels of t-PA antigen were not significantly different from normal during myocardial infarction, the capacity of the vascular endothelium to release t-PA after five minutes of venous occlusion was impaired (p less than 0.01). The acute phase vessel wall release of von Willebrand factor was increased during acute infarction (p less than 0.01). We conclude that impairment of t-PA production is associated with acute coronary thrombosis, although it is not possible to differentiate between a causative role or a secondary response due to exhaustion of the t-PA producing mechanism.
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Affiliation(s)
- R M Norris
- Coronary-Care Unit, Green Lane Hospital, Auckland, New Zealand
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19
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Andreotti F, Roncaglioni MC, Hackett DR, Khan MI, Regan T, Haider AW, Davies GJ, Kluft C, Maseri A. Early coronary reperfusion blunts the procoagulant response of plasminogen activator inhibitor-1 and von Willebrand factor in acute myocardial infarction. J Am Coll Cardiol 1990; 16:1553-60. [PMID: 2123906 DOI: 10.1016/0735-1097(90)90300-e] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The effects of early coronary recanalization on the plasma levels of two procoagulant acute phase proteins, the fastacting plasminogen activator inhibitor and von Willebrand factor, were investigated in 24 patients with myocardial infarction receiving intravenous recombinant tissue-type plasminogen activator (rt-PA) within 6 h of the onset of symptoms. Coronary angiography was performed before and 90 min after the start of rt-PA infusion. Continuous electrocardiographic recordings and 4 h plasma creatine kinase MB isoenzyme (CK MB) were performed over the first 24 h. Plasma plasminogen activator inhibitor activity, von Willebrand factor and C-reactive protein were measured before rt-PA infusion, daily for the first 3 days and after 90 days. In the entire group, plasminogen activator inhibitor activity peaked at 24 h (day 1), representing a significant increase over values at all other times (p = 0.03). von Willebrand factor was higher in the first 2 days of infarction compared with after 90 days (p = 0.001). C-reactive protein peaked on day 2, with an eightfold increase over values on admission (p = 0.001). In the 16 patients with a patent infarct-related artery at 90 min, infarct size estimated by integrated 24 h CK MB, time for ST segment elevation to decrease to half-maximum and peak C-reactive protein were reduced significantly by more than twofold compared with values in the 8 patients with an occluded artery at 90 min. The patients with early recanalization also had lower plasminogen activator inhibitor activity on day 2 (p = 0.05) and day 3 (p = 0.02) and lower 0 to 72 h averaged von Willebrand factor (p = 0.01). Thus, early coronary recanalization curtails the response of plasminogen activator inhibitor activity and von Willebrand factor to myocardial infarction, most likely by reducing the extent of ischemia and necrosis and the consequent acute phase reaction. By blunting the early postinfarction procoagulant state, prompt recanalization may reduce the risk of thromboembolic complications in the first days after myocardial infarction.
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Affiliation(s)
- F Andreotti
- Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England
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20
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Mattila K, Rasi V, Nieminen M, Valtonen V, Kesäniemi A, Syrjälä S, Jungell P, Huttunen JK. von Willebrand factor antigen and dental infections. Thromb Res 1989; 56:325-9. [PMID: 2617473 DOI: 10.1016/0049-3848(89)90174-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- K Mattila
- First Department of Medicine, Helsinki University Central Hospital, Finland
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