C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting

Area of Science:

• Cardiovascular Medicine
• Clinical Chemistry
• Hematology

Background:

• Inflammation plays a key role in coronary artery disease (CAD) progression.
• C-reactive protein (CRP) is a marker of inflammation associated with increased risk of ischemic events and hypercoagulability after coronary stenting.
• Heightened blood clot strength, measured by thrombelastography (TEG), is also linked to adverse outcomes post-stenting.

Purpose of the Study:

• To investigate the relationship between C-reactive protein (CRP) levels and plasma fibrin clot strength in patients following coronary stenting.
• To determine if CRP influences clot strength independently of fibrinogen concentration.

Main Methods:

• Plasma fibrin clot strength was measured using thrombelastography (TEG) in 54 patients 16-24 hours after elective percutaneous coronary intervention (PCI).
• Coagulation was initiated in citrated plasma with kaolin and CaCl2.
• Plasma levels of CRP and fibrinogen were quantified using enzyme-linked immunoassay.

Main Results:

• Increasing quartiles of CRP were significantly associated with increased maximal plasma fibrin clot strength (P < 0.001) and body mass index (BMI) (P = 0.04).
• Patients in the highest CRP quartile exhibited significantly greater maximal fibrin clot strength compared to those in the lowest quartile (G: 3438 ± 623 vs. 2184 ± 576 dyn/cm, P < 0.0001).
• Fibrinogen concentration did not differ significantly across CRP quartiles (P = 0.97).

Conclusions:

• Patients with coronary artery disease undergoing stenting and elevated CRP levels post-PCI demonstrate increased maximal plasma fibrin clot strength.
• The prothrombotic risk associated with elevated CRP may be mediated by procoagulant changes and enhanced fibrin clot tensile strength, irrespective of fibrinogen levels.