Plasma markers of activated hemostasis in the early diagnosis of acute coronary syndromes.
BACKGROUND
Because acute coronary syndromes (ACS) are caused by intracoronary thrombosis, plasma markers of coagulation have relevance for early diagnosis.


OBJECTIVE
To provide a critical review of these studies and specific attempts to close the diagnostic time gap left by traditional plasma markers of heart injury.


METHODS
Studies of ACS patients, with at least one control group, were included when blood samples were taken within 24 h after first symptoms prior to medication or intervention. Special attention was paid to studies reporting diagnostic performance, or combination of several markers into a single diagnostic index.


RESULTS
Markers with short plasma half-life (FPA, TAT, etc.) reflect ongoing thrombosis and may identify patients at increased risk. Markers with longer half-life (F1+2, D-Dimer, etc.) may be more useful to indicate a single acute thrombotic event. However, results are highly variable and depend on sampling time, clot property, degree of coronary obstruction and physiological condition. Early diagnostic performance of hemostatic markers was poor even when combined with heart injury markers.


CONCLUSIONS
Early measurement of hemostatic plasma markers in ACS patients provides pathophysiological information and may be helpful in risk stratification or to monitor anticoagulant therapy, but does not seem useful in routine clinical diagnosis of ACS.
van der Putten
Roy F M
RF
Cardiovascular Research Institute Maastricht, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Glatz
Jan F C
JF
Hermens
Wim Th
WT
D000208:Acute Disease; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis*; D042241:Early Diagnosis; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000175:diagnosis; D013997:Time Factors
D015415:Biomarkers