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Published on: April 1, 2015

Pre-thrombotic state and impaired fibrinolytic potential in coronary heart disease patients with left ventricular

Ferruchio De Lorenzo1, Han Xiao, Mike Scully

  • 1Thrombosis Research Institute, London, UK. dlorenzo@tri-london.ac.uk

Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis
|January 25, 2003
PubMed

Insights

Patients with coronary heart disease (CHD) experiencing myocardial stunning or necrosis show a hypercoagulable state. This suggests they are at high risk for recurrent ischemic events and may benefit from aggressive anticoagulant therapy.

Area of Science:

  • Cardiology
  • Hematology
  • Vascular Biology

Background:

  • Patients with coronary heart disease (CHD) face significant risks of recurrent ischemic events.
  • A pro-thrombotic state and/or impaired fibrinolysis are implicated in these recurrent events.

Purpose of the Study:

  • To investigate the relationship between inducible ischemia, myocardial viability, and hemostatic/fibrinolytic markers in CHD patients.
  • To assess if patients with stunned/necrotic myocardium exhibit a pro-thrombotic state and altered fibrinolysis.

Main Methods:

  • 257 CHD patients underwent dobutamine stress echocardiography (DSE) to detect inducible ischemia.
  • Evaluated resting wall motion abnormalities, Factor VIII activity, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), and tissue-type plasminogen activator (t-PA) activity.
  • Compared these markers between patients with and without resting wall motion abnormalities.

Main Results:

  • 89 patients had stunned/necrotic myocardium (resting wall motion abnormalities).
  • These patients showed significantly higher Factor VIII activity and fibrinogen levels.
  • Elevated PAI-1 activity and lower t-PA activity were observed post-DSE in patients with myocardial damage.

Conclusions:

  • CHD patients with stunned/necrotic myocardium exhibit a hypercoagulable state and reduced fibrinolytic potential.
  • These findings identify a high-risk subgroup for recurrent coronary thrombosis.
  • Consideration for more aggressive anticoagulant therapy in this patient group is warranted.

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