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Thrombin generation in rheumatoid arthritis: dependence on plasma factor composition
Anetta Undas1, Matthew Gissel, Beata Kwasny-Krochin
1Institute of Cardiology, Jagiellonian University School of Medicine, Krakow, Poland.
Thrombosis and Haemostasis
|July 2, 2010
Summary
Rheumatoid arthritis (RA) patients exhibit altered thrombin generation profiles, characterized by increased thrombin levels and formation rates. These changes, linked to disease activity, suggest a prothrombotic state in RA due to specific plasma factor compositions.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Rheumatology
Background:
- Rheumatoid arthritis (RA) is linked to a higher risk of thromboembolic cardiovascular events.
- Understanding the mechanisms behind this increased risk is crucial for patient management.
Purpose of the Study:
- To investigate thrombin generation profiles in RA patients.
- To determine the dependence of these profiles on plasma factor and inhibitor composition.
Main Methods:
- Compared plasma factor compositions (II, V, VII, VIII, IX, X), antithrombin, and free tissue factor pathway inhibitor (TFPI) in 46 RA patients and controls.
- Assessed tissue factor-initiated thrombin generation computationally and empirically using individual plasma coagulation protein compositions.
- Correlated Disease Activity Score (DAS28) with coagulation parameters.
Main Results:
- RA patients showed higher fibrinogen, Factor VIII (FVIII), Protein C (PC), and free TFPI levels compared to controls.
- DAS28 correlated with several coagulation factors (FV, FVIII, FIX, FX), antithrombin, and free TFPI.
- Computational models revealed higher maximum thrombin levels and faster thrombin formation rates in RA patients, with a delayed initiation phase.
Conclusions:
- RA patients exhibit a prothrombotic phenotype characterized by enhanced thrombin generation.
- Increased FVIII levels, partially counterbalanced by free TFPI, contribute to this prothrombotic state.
- Disease activity, measured by DAS28, influences plasma coagulation profiles in RA.
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