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Patients with acute and chronic coronary syndromes have elevated long-term thrombin generation

Christina Yip1, Aruni Seneviratna2,3, Sock-Hwee Tan4

  • 1Department of Laboratory Medicine, National University Hospital (Singapore) Pte Ltd, National University Health System (NUHS), Singapore, 1E Kent Ridge Road, #13-00, Singapore, 119228, Singapore. Christina_yip@nuhs.edu.sg.

Journal of Thrombosis and Thrombolysis
|February 21, 2020
PubMed

Insights

Patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) show persistently elevated thrombin generation (TG) long after treatment. This suggests a potential benefit of adding anticoagulation to antiplatelet therapy for preventing future cardiovascular events.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Coronary artery disease (CAD) remains a major global health burden.
  • Despite advances in treatment, patients with acute coronary syndrome (ACS) face ongoing risks of cardiovascular events.
  • Thrombin generation (TG), beyond platelet activation, plays a crucial role in atherothrombotic complications.

Purpose of the Study:

  • To investigate whether coagulation activation, specifically thrombin generation (TG), remains elevated long-term in patients with ACS and chronic coronary syndrome (CCS) compared to healthy controls.
  • To assess TG profiles at various time points up to 24 months post-intervention.

Main Methods:

  • Thrombin generation (TG) profiles were measured in patients with ACS (n=114) and CCS (n=40) within 72 hours after percutaneous coronary intervention.
  • Measurements were repeated at 6, 12, and 24 months post-intervention.
  • TG levels were compared to those of healthy individuals (n=50).

Main Results:

  • Patients with ACS and CCS demonstrated persistently elevated thrombin generation (TG) at 24 months compared to healthy controls.
  • Specific markers of elevated TG included peak thrombin (ACS: 273.1 nM, CCS: 287.3 nM vs. Healthy: 234.3 nM) and velocity index (ACS: 110.2 nM/min, CCS: 111.0 nM/min vs. Healthy: 72.9 nM/min).

Conclusions:

  • The findings support the hypothesis of persistent coagulation activation in ACS and CCS patients.
  • Elevated TG suggests a potential rationale for combining anticoagulation with antiplatelet therapy to mitigate long-term ischemic events.
  • Further research is warranted to explore TG for risk stratification and identify patients who may benefit from dual pathway inhibition.

Keywords:
Acute coronary syndromeChronic coronary syndromeCoronary artery diseasePeak thrombinThrombin generationVelocity index

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