[Thrombophilic state inpatients suffering from myocardial infarction with or without carotid atherosclerotic lesions]
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G Avellone1, V Di Garbo, R Cordova
1Istituto di Clinica Medica, Università degli Studi, Palermo.
Insights
Myocardial infarction survivors show heightened blood clot formation and impaired clot breakdown, especially those with carotid artery disease. This suggests a pro-thrombotic state contributes to atherosclerosis and related complications.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Vascular Biology
Background:
- Myocardial infarction (MI) survivors often face risks of recurrent events and thromboembolic complications.
- Carotid atherosclerotic lesions are common comorbidities in cardiovascular disease patients.
- Understanding the hemostatic balance in these patients is crucial for risk stratification.
Purpose of the Study:
- To investigate metabolic, coagulation, and fibrinolytic profiles in MI survivors.
- To compare these parameters between patients with and without carotid atherosclerotic lesions.
- To identify potential thrombophilic markers associated with vascular disease progression.
Main Methods:
- 35 MI survivors were categorized into groups with (n=16) or without (n=19) carotid plaques.
- Extracranial carotid arteries were assessed using B-mode duplex scanning.
- Metabolic markers (lipids, apolipoproteins), coagulation factors (Factor VII, fibrinogen), and fibrinolytic markers (PAI, t-PA) were measured.
Main Results:
- MI patients exhibited dyslipidemia and altered apolipoprotein profiles compared to controls.
- Patients with carotid lesions showed higher triglycerides and Lipoprotein(a) [Lp(a)].
- Both MI groups displayed enhanced coagulation (Factor VII, Fibrinogen, F1+2, Thrombin-Antithrombin) and impaired fibrinolysis (lower t-PA, higher PAI) post-venous occlusion.
Conclusions:
- MI survivors exhibit a pro-thrombotic state characterized by activated coagulation and deficient fibrinolysis.
- The presence of carotid atherosclerotic lesions exacerbates this thrombophilic tendency.
- These hemostatic abnormalities may contribute to the pathogenesis of atherosclerotic vascular disease and thromboembolic events.
Abstract:
The aim of the present study was to evaluate some metabolic, coagulation and fibrinolytic parameters in 35 patients (24 males and 11 females, mean age 57 +/- 4 years) suffering from myocardial infarction more than 6 months before with or without carotid atherosclerotic lesions. After evaluation by B-mode duplex scanning system of extracranial carotid arteries, the patients were subdivided into two groups: Group 1 (n = 16, with carotid plaques or intima-media thickening) and Group 2 (n = 19, without carotid plaques or intima-media thickening). Eighteen age- and sex-matched subjects were recruited as controls (Group 3). Groups 1 and 2 displayed significantly higher levels of total cholesterol and apolipoprotein B and significantly lower levels of HDL-cholesterol and apolipoprotein A1 than Group 3, while serum triglyceride and lipoprotein (a)-Lp (a) levels were significantly higher in Group 1 as compared to the control group. Moreover, Group 1 and 2 displayed significantly higher levels of factor VII, fibrinogen, F1+2, thrombin-antithrombin complex and plasminogen activator inhibitor (PAI) post venous occlusion and significantly lower levels of tissue plasminogen activator (t-PA) post venous occlusion than Group 3. Significantly higher levels of t-PA and PAI pre venous occlusion and significantly lower levels of antithrombin III, C-protein and S-protein were observed in Group 1 as compared to controls. In patients with highest Lp(a) level, the lowest t-PA level post venous occlusion and the highest PAI level post venous occlusion were observed. Our data show an activation of coagulation and a deficient fibrinolysis in survivors of myocardial infarction, particularly in those with associated carotid atherosclerotic lesions. We speculate that this thrombophilic state may play a key role in the pathogenesis of atherosclerotic vascular disease and thromboembolic complications.