title: Detection of hypofibrinolysis in stable coronary artery disease using the overall haemostatic potential assay.
abstract: BACKGROUND
  Patients with stable coronary artery disease (CAD) are at risk of arterial thrombosis causing myocardial infarction. Detection of global haemostatic markers of hypercoagulability and hypofibrinolysis may be important for risk stratification and individualised treatment. We examined overall haemostatic potential (OHP) and thrombin generation in a group of stable CAD patients. We also sought to investigate associations between fibrinolytic inhibitors and abnormal global fibrinolysis in these patients.
  
  
  METHODS
  Blood samples were collected from 56 patients defined by coronary anatomy as symptomatically stable CAD. Medications were recorded. Samples were analysed using the global coagulation assays OHP and thrombin generation (calibrated automated thrombogram, CAT), platelet aggregometry measured by Multiplate®, and levels of plasminogen activator inhibitor-1 (PAI-1) antigen measured by ELISA. Results were compared with a reference group of healthy controls.
  
  
  RESULTS
  Stable CAD patients displayed increased fibrin and thrombin generation and impaired fibrinolysis (decreased overall fibrinolytic potential, OFP, and increased clot lysis time) compared with healthy controls. No effect of antiplatelet agents or other medications on these parameters was observed using platelet-poor plasma. After multivariate adjustment, OFP of healthy individuals was significantly associated with fibrinogen, but in CAD patients PAI-1 became an important determinant.
  
  
  CONCLUSIONS
  Hypercoagulability of plasma is observed in stable CAD, with both increased thrombin generation and reduced fibrinolytic potential making a significant contribution. The OHP assay may provide a simple method of identifying hypercoagulability in individual patients.
authors.affiliation: ANZAC Research Institute, University of Sydney, Australia.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Reddel
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Curnow
authors.forename: Jasmin
authors.initials: J
authors.lastname: Voitl
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosenov
authors.forename: Gabrielle J
authors.initials: GJ
authors.lastname: Pennings
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Morel-Kopp
authors.forename: David B
authors.initials: DB
authors.lastname: Brieger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D003324:Coronary Artery Disease / Q000097:blood*; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013917:Thrombin / Q000378:metabolism
chemical_list: D013917:Thrombin