Plasma fibrin clot structure and thromboembolism: clinical implications

Fibrin formed as a result of fibrinogen polymerization is the main protein component of a clot in a test tube and intravascular thrombi in vivo. Fibrin clot structure characterized by fiber diameter and pore size differs between healthy persons and those with thromboembolic diseases, in part due to the quality and quantity of fibrinogen and the magnitude of thrombin generation. A key measure of plasma clot structure is its permeability, reflected by the Darcy constant (Ks). Reduced Ks is a typical feature of the prothrombotic fibrin clot phenotype, which is associated with faster formation of denser fibrin mesh, relatively resistant to lysis. Low Ks has been reported in patients with prior or acute myocardial infarction (MI), stroke, or venous thromboembolism (encompassing deep vein thrombosis [DVT] and pulmonary embolism [PE]), as well as in those with prothrombotic conditions (eg, in several thrombophilic states) and in the presence of cardiovascular risk factors (eg, obesity). Antithrombotic and anticoagulant agents, along with statins, have been shown to increase Ks. Growing evidence indicates associations between the properties of plasma fibrin clots and morphology of intravascular thrombi in patients with MI. Recently, reduced Ks has been shown to predict recurrent thromboembolic episodes in patients with a history of stroke, PE, DVT, and their serious complications, including postthrombotic syndrome and thromboembolic pulmonary hypertension. We discuss the current evidence for the significance of clot density measured in vitro as a prognostic marker in a number of clinical conditions associated with elevated thromboembolic risk.