Tissue factor pathway inhibitor, natural coagulation inhibitors and hemostatic activation markers in patients with acute coronary syndromes.
OBJECTIVE
This study aims at characterizing the hemostatic changes, in a large cohort of Saudi Arab patients with acute coronary syndromes.


METHODS
We consecutively enrolled 389 patients (unstable angina [UA]: n=181; myocardial infarction [MI]: n=208) in this study at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the period from April 2000 to November 2001. We collected blood samples before coronary angiography. Controls (n=101) were healthy males and females. All hemostatic assays were undertaken using enzyme linked immunosorbent assay based techniques and commercial kits.


RESULTS
The mean plasma levels of both bound and free tissue factor pathway inhibitors (TFPI) were significantly higher and to comparable levels, in patients with MI and UA, than in healthy control levels. Markers of thrombin generation: the mean levels of prothrombin fraction 1+2, thrombin antithrombin complexes, and D-Dimer were very significantly elevated in the 2 patients groups than in controls. Proteins C and antithrombin III showed statistically significant reduction especially in patients with MI. Plasminogen activator inhibitor levels were significantly elevated in the 2 patient groups, but were higher in MI patients. The mean levels of fibrinogen and D-Dimer as well thrombin antithrombin complex were higher and the levels of free tissue factor pathway inhibitor were lower in patients with 3-vessel coronary artery disease than those with single and double vessel disease.


CONCLUSIONS
The results of this study confirm the existence, and to a similar extent, of a hypercoagulable state in Saudi patients with MI than UA and in those with 3-vessel coronary artery disease than those with one or 2-vessel disease.
Department of Cardiology, College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. malnozha@hotmail.com
Mansour M
MM
Al-Nozha
Abdel-Galil M
AG
Abdel-Gader
Mohammed R
MR
Arafah
Mohammed A
MA
Al-Maatouq
Maie S
MS
Al-Shahid
Saad S
SS
Al-Harthi
Nazeer B
NB
Khan
Moheeb A
MA
Abdullah
D000789:Angina, Unstable / Q000097:blood* / Q000473:pathology; D001779:Blood Coagulation Factors / Q000032:analysis*; D005260:Female; D006487:Hemostasis; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology; D013917:Thrombin / Q000032:analysis
D001779:Blood Coagulation Factors; D008074:Lipoproteins; C051928:lipoprotein-associated coagulation inhibitor; D013917:Thrombin