title: Chronic Migraineurs Form Carboxyhemefibrinogen and Iron-Bound Fibrinogen.
abstract: Chronic migraine (CM) is a disabling painful condition that is associated with dementia and thrombotic disease. It has been proposed that carbon monoxide (CO) and iron may play a role in CM, and CO and iron are products of the heme oxygenase system which is widespread within the brain. Further, CO and iron enhance plasmatic coagulation in part via a fibrinogen-dependent mechanism. Thus, our goal was to determine whether patients with CM had experienced carboxyhemefibrinogen formation, iron bound fibrinogen formation and plasmatic hypercoagulability. Nonsmokers with CM were recruited after informed, written consent. Blood was collected, anticoagulated with sodium citrate, and then centrifuged with plasma stored at -80ºC. Carboxyhemefibrinogen formation, iron bound fibrinogen formation and coagulation kinetics were determined via thrombelastographic methods. Patient results were compared with laboratory values generated from normal control plasmas. Incidence (95% confidence intervals) of the various parameters was determined using the Clopper-Pearson method. Twenty-six CM patients (24 female) were recruited; they were 46±12 years old. With regard to fibrinogen modification, 88.5% (69.8%-97.6%) of CM patients had formation of carboxyhemefibrinogen, iron bound fibrinogen, or both. With regard to coagulation, 42.3% (23.4%-63.1%) of patients had abnormally decreased time to clot initiation, 80.8% (60.6%-93.4%) had abnormally large velocity of clot formation, and 46.2% (26.6%-66.7%) had abnormally strong clot strength. Patients with CM have a large incidence of carboxyhemefibrinogen and iron bound fibrinogen formation and hypercoagulability. Confirmatory and potential therapeutic clinical trials targeting CO and iron modified hypercoagulation as a source of pain and vascular disease in CM patients are indicated.
authors: University of Arizona, Anesthesiology, Tucson, AZ, Arizona, USA. vnielsen@anesth.arizona.edu.
authors: Vance Girard
authors: VG
authors: Nielsen
authors: Wendi
authors: W
authors: Kulin
authors: John Samuel
authors: JS
authors: LaWall
authors: Felesia Nancy
authors: FN
authors: MacFarland
authors: Andrew
authors: A
authors: Chen
authors: Heidi Adelleen
authors: HA
authors: Hadley
authors: Adam James
authors: AJ
authors: DaDeppo
authors: Evangelina Barbara
authors: EB
authors: Steinbrenner
authors: Ryan William
authors: RW
authors: Matika
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D015992:Body Mass Index; D002248:Carbon Monoxide / Q000097:blood*; D002908:Chronic Disease; D002951:Citrates / Q000494:pharmacology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000097:blood*; D007700:Kinetics; D007816:Larva Migrans, Visceral / Q000097:blood*; D008297:Male; D008875:Middle Aged; D000077559:Sodium Citrate
chemical_list: D000925:Anticoagulants; D002951:Citrates; D000077559:Sodium Citrate; D002248:Carbon Monoxide; D005340:Fibrinogen; D007501:Iron