Differences in fibrin fiber diameters in healthy individuals and thromboembolic ischemic stroke patients

Abstract

Cerebrovascular disease is one of the leading causes of death and the cause of long-term adult disability. An important characteristic of thromboembolic ischemic stroke is a prothrombotic or hypercoagulable state and altered fibrin clot structure, whereas a resistance to fibrinolysis is also present. An expansive fibrin network is created when adding thrombin, and in stroke, the network appears thickened, netted and matted, compared with that of healthy individuals. Although this is clearly visible in micrographs of patients, there is a need to quantify the changes. The current study, therefore, investigates fibrin fiber diameters in stroke patients and compares it to healthy individuals. The fiber diameters were measured in nanometres, with University of Texas Health Science Center at San Antonio (UTHSCSA) Image Tool. A total of 100 measurements were done for each of the 12 patients in the healthy control group, and the same number of measurements was done for 12 stroke patients. These measurements were statistically analysed with NCSS 2007, using a significance level of 0.05. Normality was assessed with the Shapiro-Wilk W test and the thickest and thinnest fiber of each individual in the two groups was quantified and differences between groups were assessed with the Student's t-test. Results showed that there is a statistical difference in fibrin fiber thickness during thromboembolic ischemic stroke. We conclude that the changed coagulation and hemostasis, typically associated with stroke, causes a statistically relevant change in fibrin thickness, and that this netted and matted network is more resistant to lyses.

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“…However, we and others have observed that their diameter and morphology changes markedly in a variety of vascular and inflammatory diseases, typically producing 'dense matter deposits' (e.g. (Jörneskog et al, 1996;Dunn and Ariëns, 2004;Dunn et al, 2005;Dunn et al, 2006;Pieters et al, 2006;Alzahrani and Ajjan, 2010;Pretorius et al, 2011a;Pretorius et al, 2011b;Alzahrani et al, 2012;Pretorius and Kell, 2014;Pretorius et al, 2015)).…”

“…When thrombin is added to the platelet poor plasma (PPP) of healthy controls, the fibres forming the subsequent clot appear like a plate of noodles or spaghetti in the scanning electron microscope (Campbell et al, 2010;Pretorius et al, 2011b;Weigandt et al, 2012;Bester et al, 2015;Kell and Pretorius, 2015b). However, we and others have observed that their diameter and morphology changes markedly in a variety of vascular and inflammatory diseases, typically producing 'dense matter deposits' (e.g.…”

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“…A representative micrograph of each sample was selected, and subsequently a 10x5 grid was superimposed onto the picture. One fiber was randomly selected out of every block of the grid, ensuring that fiber measurements were not duplicated, and that fibers were systematically assessed to prevent observer bias [29,30]. Fibrin fiber thickness was measured with ImageJ (ImageJ is a public domain, Java-based image processing program developed at the National Institutes of Health: http://rsbweb.nih.gov/ij/).…”

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“…2C shows an extensive fibrin network created with added human thrombin. These figures are representative micrographs chosen from our database of hundreds of micrographs let and erythrocyte morphology to be drastically altered in stroke 15,16,[49][50][51][52] , showing thrombo-embolic ischaemic stroke to be a hypercoagulable or prothrombotic condition 16) . This technique provides detailed, high resolution images that can show specific changes to ultrastructure.…”

“…The formed thrombus can either become embedded in a fibrin network (which forms after tissue factor release has activated the extrinsic coagulation pathway) or break away because of high shear forces, becoming an embolus. Central to the involvement of platelets is an aberrant coagulation pathway physiology, leading to a matted clot consisting of dense fibrin fibers [15][16][17] . Fig.…”