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Laboratory markers of hypercoagulability
M L Rossi1, P A Merlini, D Ardissino
1A. De Gasperis Cardiology Department, Hospital Niguarda Ca' Granda, Milan, Italy. marcolrossi@hotmail.com
Insights
A prolonged hypercoagulable state, indicated by elevated hemostatic variables like fibrinogen, significantly increases the risk of myocardial infarction and sudden death, especially in younger individuals. New sensitive assays aid in defining these states.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Thrombosis Research
Background:
- Coronary artery thrombosis is the primary cause of myocardial infarction and unstable angina.
- A prolonged hypercoagulable state is a recognized precursor to thrombotic events.
- Established associations exist between plasma hemostatic variables and myocardial infarction frequency.
Purpose of the Study:
- To analyze the significance of new, more sensitive assays for hypercoagulable states.
- To define the role of these assays in various clinical conditions.
- To understand the biochemical definition of hypercoagulability.
Main Methods:
- Review of investigations over the last 40 years.
- Analysis of associations between plasma hemostatic variables and myocardial infarction.
- Evaluation of newly developed sensitive assays for hemostatic factors.
Main Results:
- High levels of fibrinogen, factor VII/VIIa, tissue-type plasminogen activator, and plasminogen activator inhibitor are linked to increased risk of myocardial infarction, reinfarction, or sudden death.
- This risk is comparable to that associated with high cholesterol, particularly in younger populations.
- New sensitive assays enable precise biochemical definition of hypercoagulable states.
Conclusions:
- Elevated hemostatic variables represent a significant risk factor for thrombotic cardiovascular events.
- Advanced diagnostic assays are crucial for accurately identifying and characterizing hypercoagulable states.
- Understanding hypercoagulability is key to preventing myocardial infarction and related events.
Abstract:
Investigations carried out over the last 40 years have demonstrated that coronary artery thrombosis is the critical event underlying myocardial infarction and unstable angina. The existence of a prolonged hypercoagulable state preceding the thrombotic event has been postulated for some time and significant associations have been established between the plasma concentrations of a number of hemostatic variables and the frequency of myocardial infarction. High plasma fibrinogen, factor VII/VIIa, tissue-type plasminogen activator and plasminogen activator inhibitor levels have been associated with at least as great a risk of developing myocardial (re)infarction or sudden death as high cholesterol levels, especially in the young. In the last year more sensitive assays have been developed, and they should allow a precise biochemical definition of hypercoagulable states. The significance of these new assays and their role in defining a hypercoagulable state in different conditions are analyzed.