title: Fibrin clot formation and fibrinolysis in patients with a history of coronary stent thrombosis.
abstract: BACKGROUND
  Coronary stent thrombosis is a devastating complication of percutaneous coronary intervention (PCI). Multiple factors underlie the pathophysiological mechanisms of stent thrombosis. Previous studies demonstrated that patients with stent thrombosis, compared to control PCI patients, formed denser fibrin clots in vitro which were more resistant to fibrinolysis, suggesting that altered fibrin clot properties may contribute to the pathophysiology of stent thrombosis. We assessed the plasma fibrin clot formation and fibrinolysis of patients with and without stent thrombosis.
  
  
  METHODS
  Cases (patients with stent thrombosis) and matched controls (patients without stent thrombosis) were included for a matched case-control study. Matching was performed on indication and time of the index PCI (initial stent implantation) from the cases. Fibrin clot formation and fibrinolysis were assessed in vitro by turbidimetric assays, with human thrombin to initiate fibrin polymerization and tissue type plasminogen activator to initiate fibrinolysis. Lag time, maximal absorbance and clot lysis time were determined by these assays.
  
  
  RESULTS
  In total, 27 cases and 27 controls were included. No significant differences were observed between cases and controls in lag time (173 vs. 162s, p=0.18), maximal absorbance (0.78 vs. 0.83, p=0.36), and clot lysis time (69 vs. 71min, p=0.78). Fibrin clot formation and fibrinolysis were not associated with stent thrombosis.
  
  
  CONCLUSIONS
  Plasma fibrin clot formation and fibrinolysis were not significantly different between patients with stent thrombosis and matched control patients, suggesting that fibrin clot formation and fibrinolysis play no significant role in the pathophysiology of stent thrombosis.
authors.affiliation: St Antonius Center for Platelet Function Research, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. Electronic address: t.godschalk@antoniusziekenhuis.nl.
authors.forename: Thea C
authors.initials: TC
authors.lastname: Godschalk
authors.affiliation: Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands. Electronic address: j.konings@thrombin.com.
authors.forename: Joke
authors.initials: J
authors.lastname: Konings
authors.affiliation: Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands. Electronic address: j.govers@maastrichtuniversity.nl.
authors.forename: José W
authors.initials: JW
authors.lastname: Govers-Riemslag
authors.affiliation: St Antonius Center for Platelet Function Research, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. Electronic address: jurtenberg@gmail.com.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.affiliation: St Antonius Center for Platelet Function Research, Department of Clinical Chemistry, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. Electronic address: c.hackeng@antoniusziekenhuis.nl.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Hackeng
authors.affiliation: Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands. Electronic address: h.tencate@maastrichtuniversity.nl.
authors.forename: Hugo
authors.initials: H
authors.lastname: Ten Cate
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003328:Coronary Thrombosis / Q000097:blood* / Q000209:etiology* / Q000378:metabolism; D005260:Female; D005337:Fibrin / Q000378:metabolism; D063285:Fibrin Clot Lysis Time; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*
chemical_list: D005337:Fibrin
keywords: Coronary thrombosis; Fibrin; Fibrinolysis; Percutaneous coronary intervention; Stent