[Anomalies of coagulation and fibrinolytic activity in patients with chronic pulmonary thromboembolism].
BACKGROUND
Haemostatic and fibrinolytic parameters were evaluated in patients with chronic pulmonary hypertension following pulmonary embolism (CPE). The diagnosis of CPE was based on lobar or segmental defects on perfusion lung scans and by pulmonary angiograms which showed complete or partial obstruction of main or segmentary lobar arteries.


METHODS
Antithrombin III (AT III), protein C, protein S, and lupus anticoagulant (LA) were assayed in 8 patients with CPE; in 6 out of 8 patients plasma fibrinolytic activity was assessed both under basal conditions and after venous stasis. The control group consisted of 4 normal subjects. Protein C and protein S antigens were assayed by an electrophoretic method. Protein C and protein S biological activities were assayed by a manual clotting system. AT III was assayed by chromogenic method. Fibrinolytic total activity was studied on fibrin plates, tPA and PAI-1 activities by chromogenic method; tPA and PAI-1 antigens by ELISA technique.


RESULTS
One patient out of 8 showed a protein C deficiency and 3 patients out of 8 were positive for a LA. All patients had a statistically significant reduction of plasma fibrinolytic activity (p < 0.001) and of tPA activity (p < 0.0005) after venous stasis as compared to the control group.


CONCLUSIONS
Our data show that significant haemostatic abnormalities may underlie this disease. In particular, a) an impairment of fibrinolytic plasma activity and low levels of plasminogen activator may be found, and b) the undiagnosed presence of a LA may be the cause of these thrombotic events. The meaning of these results needs further assessment.
Aiello
E
E
Divisione di Cardiologia, Ospedale Giovanni Bosco, Torino.
Presbitero
P
P
Stella
S
S
Borchiellini
A
A
Garis
G
G
Bazzan
M
M
Schinco
P
P
Tamponi
G
G
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D002908:Chronic Disease; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000097:blood; D011655:Pulmonary Embolism / Q000097:blood* / Q000150:complications; D010959:Tissue Plasminogen Activator / Q000097:blood
D016682:Lupus Coagulation Inhibitor; D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D017293:Protein S; D000990:Antithrombin III; D010959:Tissue Plasminogen Activator
Anomalie della coagulazione e dell'attività fibrinolitica nei pazienti con tromboembolia polmonare cronica.