Hemostatic tests in the prediction of atherothrombotic disease

Hemostatic components play major roles in the pathogenesis of human atherothrombotic disease. There has been interest in determining whether tests for hemostatic components predict this disorder. Recent population-based and clinically-oriented prospective studies have begun to provide useful information. Northwick Park Heart (NPH) study made the initial observation that the plasma fibrinogen level is an independent risk factor for non-fatal and fatal coronary heart disease (CHD). This has been confirmed by other population-based studies. By contrast, factor VIIc levels which were reported by NPH to be an independent risk factor for CHD, especially fatal myocardial infarction (MI) has not been confirmed by other studies. Factor VIIIc, von Willebrand factor (vWF), tPA and PAI-1 are reported to be associated with CHD. Prospective angina pectoris studies have identified fibrinogen, C-reactive protein (CRP) and von Willebrand factor as independent risk factors for acute MI. These findings raise a possible mechanism of inflammation in CHD. A number of studies imply an association of platelet activation with CHD. A prospective study has shown that a persistent positive spontaneous platelet aggregation (SPA) test is an independent risk factor for recurrent MI. Hence, prospective studies indicate a potential value for certain hemostatic tests to predict atherothrombotic disorder. However, clinical utility of these tests remains to be established. Controlled clinical trials may be required to provide a more definite information regarding the use of these tests for selecting high risk patients for preventive strategies.