Involvement of tissue factor pathway inhibitor in the coronary circulation of patients with acute coronary syndromes.
BACKGROUND
Tissue factor pathway inhibitor (TFPI) is the endogenous inhibitor of the extrinsic coagulation pathway; however, its involvement during thrombus formation in patients with acute coronary syndromes (ACS) is still unknown.


RESULTS
Transcardiac (aorta/coronary sinus) free and total TFPI (free + lipoprotein-bound form) levels, as well as TFPI/factor Xa (FXa) complex levels, were measured in plasma samples obtained from patients with acute myocardial infarction undergoing primary PTCA and patients with unstable angina undergoing urgent PTCA. Patients with stable angina undergoing elective PTCA served as controls. In addition, prothrombin fragment 1+2 and fibrinopeptide A plasma levels were measured. Samples were collected at baseline, after PTCA, and after stent deployment. In patients with ACS, both total and free TFPI plasma levels in the coronary sinus were significantly lower than the corresponding levels measured in the aorta at any time point of the study; conversely, a significant increase in TFPI/FXa complex plasma levels was observed in the coronary sinus as compared with the aorta. In contrast, in patients with stable angina, no differences were observed in TFPI and TFPI/FXa levels at baseline in the coronary sinus as compared with the aorta.


CONCLUSIONS
TFPI is involved in the process of thrombus formation in vivo in patients with ACS, which suggests a potential role for TFPI in modulating coronary thrombosis.
Golino
Paolo
P
Department of Internal Medicine and Cardiovascular Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy. paolo.golino@unina2.it
Ravera
Amelia
A
Ragni
Massimo
M
Cirillo
Plinio
P
Piro
Orlando
O
Chiariello
Massimo
M
D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000628:therapy; D000789:Angina, Unstable / Q000097:blood* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use; D001011:Aorta; D003326:Coronary Circulation / Q000502:physiology*; D003328:Coronary Thrombosis / Q000378:metabolism; D003331:Coronary Vessels; D015951:Factor Xa / Q000032:analysis / Q000502:physiology*; D005260:Female; D005342:Fibrinolysis; D005344:Fibrinopeptide A / Q000032:analysis; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008074:Lipoproteins / Q000032:analysis / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D010446:Peptide Fragments / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D015607:Stents; D013917:Thrombin / Q000502:physiology; D019851:Thrombophilia / Q000097:blood
D000925:Anticoagulants; D008074:Lipoproteins; D010446:Peptide Fragments; C051928:lipoprotein-associated coagulation inhibitor; C045879:prothrombin fragment 1.2; D005344:Fibrinopeptide A; D011516:Prothrombin; D006493:Heparin; D013917:Thrombin; D015951:Factor Xa