Altered plasma fibrin clot properties are associated with in-stent thrombosis.
OBJECTIVE
We sought to investigate whether patients with in-stent thrombosis (IST) display altered plasma fibrin clot properties.


RESULTS
We studied 47 definite IST patients, including 15 with acute, 26 subacute and 6 late IST, and 48 controls matched for demographics, cardiovascular risk factors, concomitant treatment and angiographic/stent parameters. Plasma clot permeability (K(s)), which indicates a pore size, turbidity (lag phase, indicating the rate of fibrin clot formation, DeltaAbs(max), maximum absorbance of a fibrin gel, reflecting the fiber thickness), lysis time (t(50%)) and maximum rate of D-dimer release from clots (D-D(rate)) were determined 2 to 73 (median 14.7) months after IST. Patients with IST had 21% lower K(s), 14% higher DeltaAbs(max), 11% lower D-D(rate), 30% longer t(50%) (all P<0.0001) and 5% shorter lag phase compared to controls (P=0.042). There were no correlations between clot variables and the time of IST or that from IST to blood sampling. Multiple regression analysis showed that K(s) (odds ratio=0.36 per 0.1 microm(2), P<0.001), D-D(rate) (odds ratio=0.16 per 0.01 mg/L/min, P<0.001) and stent length (odds ratio=1.1 per 1 mm, P=0.043) were independent predictors of IST (R(2)=0.58, P<0.001).


CONCLUSIONS
IST patients tend to form dense fibrin clots resistant to lysis, and altered plasma fibrin clot features might contribute to the occurrence of IST.
Undas
Anetta
A
Institute of Cardiology, Jagiellonian University School of Medicine, 31-202 Cracow, Poland. mmundas@cyf-kr.edu.pl
Zalewski
Jaroslaw
J
Krochin
Marek
M
Siudak
Zbigniew
Z
Sadowski
Marcin
M
Pregowski
Jerzy
J
Dudek
Dariusz
D
Janion
Marianna
M
Witkowski
Adam
A
Zmudka
Krzysztof
K
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D016022:Case-Control Studies; D017023:Coronary Angiography; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D007700:Kinetics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D016017:Odds Ratio; D010539:Permeability; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome
D005338:Fibrin Fibrinogen Degradation Products; D010975:Platelet Aggregation Inhibitors; C036309:fibrin fragment D; D005337:Fibrin