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The hypercoagulable profile of patients with stent thrombosis

R Loeffen1, T C Godschalk2, R van Oerle1

  • 1Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.

Heart (British Cardiac Society)
|May 23, 2015
PubMed

Insights

Patients with coronary stent thrombosis exhibit enhanced thrombin generation, indicating a hypercoagulable state. This may stem from increased contact activation and impaired protein C pathway function following percutaneous coronary intervention.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Thrombosis Research

Background:

  • Coronary stent thrombosis is a severe complication of percutaneous coronary intervention (PCI).
  • The precise mechanisms driving stent thrombosis remain multifactorial and incompletely understood.
  • The role of the coagulation system in stent thrombosis pathophysiology requires further elucidation.

Purpose of the Study:

  • To investigate the hypothesis that thrombin generation is elevated in patients experiencing stent thrombosis.
  • To explore the involvement of the contact activation system and protein C pathway in the hypercoagulable state associated with stent thrombosis.

Main Methods:

  • A case-control study involving 63 patients who underwent PCI (23 with stent thrombosis, 40 without).
  • Measurement of thrombin generation using varying tissue factor (TF) triggers (0, 1, and 5 pM).
  • Assessment of contact activation using active site-inhibited factor VIIa (ASIS) and the protein C pathway with recombinant thrombomodulin.

Main Results:

  • Significantly increased thrombin generation was observed in stent thrombosis cases across all TF triggers compared to controls.
  • Enhanced contact activation was evident in cases (mean peak height 241 nM) versus controls (183 nM) without exogenous TF.
  • Thrombin generation remained elevated in cases (263 nM) versus controls (233 nM) with 5 pM TF; thrombomodulin addition indicated potential protein C pathway alterations.

Conclusions:

  • This study provides the first evidence suggesting the coagulation system's involvement in stent thrombosis.
  • Patients with stent thrombosis demonstrate a hypercoagulable state.
  • This hypercoagulability is likely attributed to heightened contact activation and a compromised protein C pathway.
Abstract

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