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Implications of Hemostasis Disorders in Patients with Critical Limb Ischemia-An In-Depth Comparison of Selected

Radosław Wieczór1,2, Arleta Kulwas1, Danuta Rość1

  • 1Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.

Journal of Clinical Medicine
|March 4, 2020
PubMed

Insights

Patients with critical limb ischemia (CLI) show significant coagulation activation, with higher levels of tissue factor (TF) and thrombin-antithrombin complex (TAT). This indicates a prothrombotic state with increased fibrinolysis in CLI patients.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Vascular Surgery

Background:

  • Peripheral arterial disease (PAD) and critical limb ischemia (CLI) are associated with high mortality.
  • Blood coagulation disorders significantly contribute to PAD/CLI pathogenesis.
  • Tissue factor (TF) plays a crucial role in the coagulation cascade.

Purpose of the Study:

  • To investigate the activation of the coagulation system, specifically via tissue factor (TF), in patients with CLI.
  • To compare coagulation parameters in CLI patients versus those with intermittent claudication (IC).

Main Methods:

  • Blood samples were collected from 65 CLI patients, 15 IC patients, and 30 healthy controls.
  • Assayed parameters included TF (antigen and activation), TFPI (antigen and activation), TAT, fibrinogen, platelet count, t-PA, PAI-1, and D-dimer.
  • Hemostasis parameters were measured before initiating treatment.

Main Results:

  • PAD patients exhibited significantly higher levels of most hemostasis parameters compared to healthy subjects.
  • CLI patients showed significantly higher TF antigen, TAT, fibrinogen, and D-dimer levels compared to IC patients.
  • CLI patients had decreased TF activation, lower TFPI antigen, and slightly increased TFPI activation compared to IC patients.

Conclusions:

  • Patients with CLI demonstrate activated coagulation and a prothrombotic balance.
  • Elevated D-dimer levels in CLI patients suggest secondary fibrinolysis activation.
  • The findings confirm a prothrombotic condition with heightened fibrinolysis in CLI.
Abstract

Keywords:
biomarkerscritical limb ischemiahemostasis

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