Hypercoagulability, platelet function, inflammation and coronary artery disease acuity: results of the Thrombotic RIsk Progression (TRIP) study.
The objective of the study was to determine the relation of platelet reactivity, hypercoagulability and inflammation in various stages of coronary artery disease acuity (CAD). Thrombin-induced platelet-fibrin clot strength (MA), time to initial platelet-fibrin clot formation (R), C-reactive protein (CRP), prothrombotic factors, activated GPIIb/IIIa receptor expression and other biomarkers were studied in patients with asymptomatic stable CAD (AS), in patients undergoing PCI for stable (SA) and unstable angina (UA). MA and R were measured by thrombelastography, GPIIb/IIIa expression by flow cytometry and all other markers by fluorokine multianalyte profiling assays. An overall increase in all measurements from a clinically stable to an unstable disease state was observed. There was a distinct stepwise increment in MA [AS vs. SA (p = 0.02), SA vs. UA (p = 0.02) and AS vs. UA (p < 0.001)]. MA exhibited the strongest correlation with other prothrombotic markers (p < or = 0.02), with CRP (p < 0.001) at all levels of CAD acuity. A distinct pathophysiological state of heightened platelet function, hypercoagulability and inflammation marks the presence of unstable cardiovascular disease requiring intervention. Further studies are required to investigate the primary mechanisms linking the above processes associated with a prothrombotic state resulting in clinical destabilization of the disease.
Tantry
Udaya S
US
Sinai Center for Thrombosis Research, Baltimore, Maryland 21215, USA.
Bliden
Kevin P
KP
Suarez
Thomas A
TA
Kreutz
Rolf P
RP
Dichiara
Joseph
J
Gurbel
Paul A
PA
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005434:Flow Cytometry; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D013916:Thrombelastography; D019851:Thrombophilia / Q000097:blood*
D015415:Biomarkers; D005337:Fibrin; D002097:C-Reactive Protein