Hemostatic function and carotid artery disease
C Liapis1, J Kakisis, V Papavassiliou
1Second Department of Propedeutic Surgery, Athens University Medical School, Athens, Greece.
Insights
Clotting factors like tissue plasminogen activator and PAI-1 are linked to carotid artery disease development. However, these hemostatic factors do not predict cerebrovascular events in patients with carotid stenosis.
Area of Science:
- Cardiovascular Research
- Hematology
- Neuroscience
Background:
- Conventional cardiovascular risk factors explain less than half of cardiovascular events.
- Atherogenesis involves complex pathways beyond traditional risk factors.
- The role of hemostatic factors in carotid artery disease requires further investigation.
Purpose of the Study:
- To investigate the association between clotting factors and carotid artery disease.
- To determine if clotting factors can predict cerebrovascular event risk in internal carotid artery stenosis patients.
Main Methods:
- Evaluated 26 patients with high-grade internal carotid artery stenosis and 43 age-matched controls.
- Assessed atherogenic risk factors and hemostatic function, including fibrinogen, tissue plasminogen activator (TPA), D-dimer, plasminogen activator inhibitor 1 (PAI-1), plasminogen, and factor VII:c.
- Utilized multiple linear regression analysis for statistical evaluation.
Main Results:
- Carotid artery stenosis showed significant association with elevated TPA, D-dimer, and PAI-1 levels.
- No significant correlation was found between carotid artery disease and fibrinogen, plasminogen, or factor VII:c levels.
- None of the assessed clotting factors correlated with cerebrovascular event history in patients with carotid stenosis.
Conclusions:
- The hemostatic system appears to contribute to the development of atherosclerotic carotid artery disease.
- Hemostatic factors do not seem to influence symptom development in patients with carotid stenosis.
- Further research is needed to elucidate the precise role of hemostasis in carotid artery disease progression and outcomes.
Aim:
Since conventional risk factors predict less than one half of future cardiovascular events, other factors that contribute to atherogenesis need to be evaluated. The aim of this study was to investigate whether clotting factors are associated with carotid artery disease. Furthermore, we tried to determine whether clotting factors could be used to predict the risk of cerebrovascular events in patients with internal carotid artery stenosis.
Methods:
Twenty-six patients with high-grade (>70%) internal carotid artery stenosis and 43 age-matched controls were evaluated for atherogenic risk factors and hemostatic function. Laboratory tests included plasma assays of fibrinogen, tissue plasminogen activator (TPA), D-dimer, plasminogen activator inhibitor 1 (PAI-1), plasminogen and factor VII:c. Nineteen (72%) patients had history of stroke or transient ischemic attack, while the remaining 7 (28%) were asymptomatic. Statistical analysis was performed using multiple linear regression analysis.
Results:
Carotid artery stenosis was associated with high levels of TPA (p<0.001), D-dimer (p=0.019) and PAI-1 (p<0.001). No statistically significant correlation was found between the presence of carotid artery disease and the levels of fibrinogen (p=0.28), plasminogen (p=0.96) or factor VII:c (p=0.19). As regards the clinical manifestations, none of the studied clotting factors was correlated with the history of cerebrovascular events in the patients with carotid stenosis.
Conclusion:
The results of this study show that the hemostatic system may play a role in the development of carotid artery atherosclerotic disease, while it does not seem to affect the development of symptoms in patients with carotid stenosis.
Related Concept Videos
Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Clot Retraction and Fibrinolysis

