title: Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography: A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis.
abstract: OBJECTIVE
  In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. We aimed to simultaneously assess thrombosis biomarkers and lipid levels in patients with and without ISR.
  
  
  METHODS
  Consecutive patients (n = 170) with a history of coronary stenting undergoing elective angiography were studied. Blood samples for thrombelastography, light transmittance aggregometry, and lipid levels were obtained prior to cardiac catheterization.
  
  
  RESULTS
  Sixty-nine patients (41%) had ISR (>50% luminal diameter stenosis). Among patients with ISR, 40 (58%) had ISR in more than one stent bed. Patients with ISR were more often female (37.7% vs. 21.8%, P = 0.04), had higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9 mm vs. 65.6 mm, P < 0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, P = 0.03). In patients on dual antiplatelet therapy (n = 86), there were no differences in ADP-, arachidonic acid-, and collagen-induced platelet aggregation between groups. The frequency of patients with ISR increased with TIP-FCS quartiles and by ROC analysis, TIP-FCS = 67.0 mm was the cutpoint for identification of ISR (AUC = 0.80 (95%CI 0.73-0.87, P < 0.0001). By multivariate analysis, TIP-FCS ≥67.0 mm strongly associated with ISR (OR = 7.3, P = 0.004).
  
  
  CONCLUSIONS
  Patients with ISR identified at the time of cardiac catheterization have a prothrombotic phenotype indicated by high TIP-FCS, a novel marker. Studies to confirm the prognostic utility of high TIP-FCS for the development of ISR are ongoing.
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.|Inova Heart and Vascular Institute, Inova Medical Center, Fairfax, Virginia.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Bliden
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.|Inova Heart and Vascular Institute, Inova Medical Center, Fairfax, Virginia.
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Gesheff
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Franzese
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.
authors.forename: Shachi
authors.initials: S
authors.lastname: Pandya
authors.affiliation: CGH Medical Center, Sterling, Illinois.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.
authors.forename: Denny P
authors.initials: DP
authors.lastname: Mathew
authors.affiliation: Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, Maryland.
authors.forename: Rahul
authors.initials: R
authors.lastname: Chaudhary
authors.affiliation: Inova Heart and Vascular Institute, Inova Medical Center, Fairfax, Virginia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000502:physiology*; D023903:Coronary Restenosis / Q000097:blood* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D005337:Fibrin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010974:Platelet Aggregation / Q000502:physiology*; D012372:ROC Curve; D015607:Stents / Q000009:adverse effects*; D013916:Thrombelastography / Q000379:methods*; D013917:Thrombin / Q000032:analysis
chemical_list: D015415:Biomarkers; D008055:Lipids; D005337:Fibrin; D013917:Thrombin