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[The fibrinolytic system in patients with dilated myocardiopathy]
P Fernández1, F Marín, P Marco
1Unidad de Trombosis y Hemostasia, Hospital General Universitario de Alicante.
Insights
Dilated cardiomyopathy (DCM) patients show higher levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1), indicating vascular injury and hypofibrinolysis. Long-term anticoagulation may benefit DCM management.
Area of Science:
- Cardiology
- Hematology
- Thrombosis Research
Background:
- Dilated cardiomyopathy (DCM) is associated with complex pathophysiological mechanisms.
- The fibrinolytic system plays a crucial role in regulating blood clot breakdown.
- Understanding fibrinolysis in DCM is vital for managing thrombotic complications.
Purpose of the Study:
- To investigate the fibrinolytic system in DCM patients.
- To correlate fibrinolytic markers with disease severity and complications.
- To assess the impact of antithrombotic therapy on fibrinolytic proteins.
Main Methods:
- Studied 18 DCM patients (idiopathic and ethyl) and 30 controls.
- Measured plasma levels of antigenic and functional tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1).
- Performed venous occlusion tests to assess t-PA secretion and fibrinolytic activity.
Main Results:
- DCM patients exhibited significantly higher antigenic t-PA and PAI-1 levels compared to controls (p < 0.01).
- Venous occlusion test responses were within normal limits.
- No significant correlation was found between fibrinolytic parameters and clinical data (NYHA class, complications).
Conclusions:
- Elevated t-PA suggests vascular injury and atherothrombotic risk in DCM.
- Increased PAI-1 indicates a hypofibrinolytic state in DCM patients.
- Consideration of long-term oral anticoagulation is recommended for DCM management.
Objectives:
To study the fibrinolytic system in dilated cardiomyopathy (DCM) patients, and the relationship between the degree of severity (NYHA degree), and the presence of complications (atrial fibrillation, intracavity thrombus, and peripheral embolism). We also analyzed the influence of the antithrombotic therapy on the fibrinolysis's proteins.
Patients And Methods:
We included 18 patients, stratified in two etiologic groups: 9 with idiopathic and 9 with ethyl DCM. The fibrinolytic system was investigated through the plasma levels of antigenic and functional t-PA and PAI-1. We also carried out a venous occlusion test to investigate the fibrinolytic the fibrinolytic activity in t-PA secretion. The clinical aspects were recorded. We included 30 healthy individuals matched for age and sex, as controls.
Results:
The antigenic levels of t-PA and PAI-1, were significantly higher in the DCM group than in the control group (p < 0.01). The venous occlusion test responses were normal. No relationship between the fibrinolytic parameters and clinical data were observed.
Discussion:
The high levels of antigenic t-PA found in DCM patients were considered as a vascular injury marker, and a atherothrombotic risk factor. Furthermore, there is a hypofibrinolytic condition shown by a PAI-1 augmentation. In conclusion, we are prone to consider long term oral anticoagulation in the management of DCM patients.