Related Experiment Video
Updated: Aug 21, 2026
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Lipoprotein(a), Oxidized Phospholipids and Tensile Clot Strength Measured by Thromboelastography in Patients
Paul A Gurbel1, Udaya S Tantry1, Kevin P Bliden1
1Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore and LifeBridge Health System, Baltimore, MD (P.A.G., U.S.T., K.P.B., Y.H.J.).
Insights
Lipoprotein(a) [Lp(a)] and oxidized phospholipids (OxPL) are linked to increased clot strength in cardiovascular patients. Race and gender significantly influence these factors, impacting hypercoagulability.
Area of Science:
- Cardiovascular Medicine
- Thrombosis Research
- Biomarker Discovery
Background:
- Lipoprotein(a) [Lp(a)] and tensile clot strength (TCS) are independent cardiovascular disease risk factors.
- Lp(a) carries oxidized phospholipids (OxPL), contributing to atherothrombotic properties.
Purpose of the Study:
- To investigate the relationship between Lp(a), OxPL biomarkers, and TCS in high-risk cardiovascular disease patients.
- To explore the influence of race and gender on these associations.
Main Methods:
- Subanalysis of the MBRACE trial including healthy subjects and patients with coronary artery disease, myocardial infarction, or ischemic stroke.
- Measurement of Lp(a), OxPL biomarkers (OxPL-apoB, OxPL-apo(a), OxPL-plasminogen), and total plasminogen via ELISA.
- Assessment of TCS using thromboelastography.
Main Results:
- Patients exhibited higher Lp(a), OxPL biomarkers, and TCS compared to healthy individuals.
- Black patients and females showed higher levels of Lp(a) and OxPL biomarkers, with Black females having the highest levels.
- Hypercoagulability correlated with Lp(a), OxPL-apoB, and total plasminogen; high Lp(a) associated with OxPL-apoB and OxPL-apo(a).
Conclusions:
- Lp(a), OxPL biomarkers, and TCS in high-risk patients are influenced by race and gender, correlating with hypercoagulability.
- Findings offer mechanistic insights into Lp(a) and OxPL's role in clotting propensity.
- Results may inform ongoing trials targeting Lp(a) reduction for improved patient outcomes.
Background:
Lp(a) (lipoprotein[a]) and tensile clot strength (TCS) are distinct and independent risk factors for incident cardiovascular disease and recurrent ischemic events. Lp(a) is a carrier of oxidized phospholipids (OxPL) that contribute to its atherothrombotic properties. The current objective is to study the relationship of Lp(a) and OxPL biomarkers with TCS in patients with high-risk vascular diseases.
Methods:
In a subanalysis of the ongoing MBRACE trial (Multidisciplinary Approach to Reduce Cardiovascular Health Disparities in the Baltimore Racial Minority Communities), we studied Lp(a), OxPL biomarkers, and TCS in healthy subjects (n=17) and in patients with cardiovascular disease undergoing percutaneous intervention (multivessel coronary artery disease [n=60], myocardial infarction [n=86], and ischemic stroke [n=28]). Lp(a), OxPL-apoB, OxPL-apo(a), OxPL-plasminogen (OxPL-PLG), and total plasminogen were measured using enzyme-linked immunoassays. High Lp(a) was defined as ≥125 nmol/L. TCS was measured by thromboelastography, and hypercoagulability was defined by values ≥66.5 mm.
Results:
Compared with healthy subjects, patients had higher Lp(a), OxPL-apoB, OxPL-apo(a), and TCS (P<0.05 for all). Black patients, compared with White patients, had higher Lp(a), OxPL biomarkers, and TCS (P≤0.05); whereas females had higher Lp(a) and OxPL biomarkers except OxPL-PLG (P≤0.03) and numerically higher TCS (P=0.06). Black females had the highest Lp(a), OxPL-apoB, OxPL-apo(a), and TCS (P≤0.05). In a multivariate analysis, hypercoagulability was associated with Lp(a), OxPL-apoB, and total plasminogen (P≤0.019), whereas high Lp(a) was associated with OxPL-apoB and OxPL-apo(a) (≤0.004).
Conclusions:
In patients with high-risk cardiovascular disease undergoing percutaneous intervention, Lp(a), OxPL-related biomarkers, and TCS are influenced by race and gender and correlated with hypercoagulability. These findings suggest novel mechanistic insights into the relationship between Lp(a), OxPL biomarkers, and the propensity for whole-blood clotting and may be relevant in explaining the outcomes of patients in ongoing trials targeting the reduction of Lp(a).
