Effects of exposure to air pollution on blood coagulation

Abstract

Summary. Background: Consistent evidence has indicated that air pollution increases the risk of cardiovascular diseases. The underlying mechanisms linking air pollutants to increased cardiovascular risk are unclear. Objectives: We investigated the association between the pollution levels and changes in such global coagulation tests as the prothrombin time (PT) and the activated partial thromboplastin time (APTT) in 1218 normal subjects from the Lombardia Region, Italy. Plasma fibrinogen and naturally occurring anticoagulant proteins were also evaluated. Methods: Hourly concentrations of particulate (PM 10 ) and gaseous pollutants (CO, NO 2 , SO 2 , and O 3 ) were obtained from 53 monitoring sites covering the study area. Generalized additive models were applied to compute standardized regression coefficients controlled for age, gender, body mass index, smoking, alcohol, hormone use, temperature, day of the year, and long-term trends. Results: The PT became shorter with higher ambient air concentrations at the time of the study of PM 10 (coefficient ¼ )0.06; P < 0.05), CO (coefficient ¼ )0.11; P < 0.001) and NO 2 (coefficient ¼ )0.06; P < 0.05). In the 30 days before blood sampling, the PT was also negatively associated with the average PM 10 (coefficient ¼ )0.08; P < 0.05) and NO 2 (coefficient ¼ )0.08; P < 0.05). No association was found between the APTT and air pollutant levels. In addition, no consistent relations with air pollution were found for fibrinogen, antithrombin, protein C and protein S. Conclusions: This investigation shows that air pollution is associated with changes in the global coagulation function, suggesting a tendency towards hypercoagulability after short-term exposure to air pollution. Whether these changes contribute to trigger cardiovascular events remains to be established.

Short‐term effects of air pollution on cardiovascular diseases: outcomes and mechanisms

“…Global coagulation tests (prothrombin time and activated partial thromboplastin time), as well as plasma fibrinogen levels and naturally occurring anticoagulant proteins (antithrombin, protein C and protein S), were evaluated in 1218 healthy individuals and related to the degree of air pollution (PM 10 , CO, NO 2 , SO 2 and O 3 ) in the hours and days before blood sampling. A significant correlation was found between mild shortening of the prothrombin time and the degree of air pollution, both at the time of sampling or in the 30 days prior to sampling [64]. Short-term exposure to PM 10 was also associated with increased homocysteine levels in smokers, but not in non-smokers [65].…”

“…The effects of exposure to air pollution on blood coagulation were investigated in a study conducted in the region of Lombardy in the north of Italy [64]. Global coagulation tests (prothrombin time and activated partial thromboplastin time), as well as plasma fibrinogen levels and naturally occurring anticoagulant proteins (antithrombin, protein C and protein S), were evaluated in 1218 healthy individuals and related to the degree of air pollution (PM 10 , CO, NO 2 , SO 2 and O 3 ) in the hours and days before blood sampling.…”

Particulate matter phagocytosis induces tissue factor in differentiating macrophages

“…Moreover coagulation factors such as FVII and fibrinogen, which are part of the acute phase responses mediated by cytokines released during inflammatory reactions, increase after short-term exposure to particles (Schwartz J et al, 2001;Ruckerl R et al, 2014). As already mentioned before, Baccarelli et al, (Baccarelli et al, 2007) founded that a shorter prothrombin time (PT) was associated with higher concentrations of ambient PM 10 , CO and NO 2 . This suggests that air pollution determines hypercoagulability and contributes to the increase in cardiovascular effects observed after exposure to air pollution.…”

“…Hypercoagulability and heightened platelet activation also occur through pulmonary and systemic inflammation and generate a cytokine storm, a mechanism that facilitates atherogenesis (Vermylen j et al, 2007). Baccarelli et al, demonstrated that a global coagulation test like prothrombin time (PT) becomes shorter during exposure to high ambient air concentrations of PM10 (Baccarelli A et al, 2007). This result was confirmed by Bonzini et al, who used for the first time a global functional assay of coagulability (the thrombin generation test) and demonstrated heightened thrombin formation in steel workers, who were exposed to high levels of particulate matter (Bonzini M et al, 2010).…”

Living near Major Traffic Roads and Risk of Deep Vein Thrombosis.

“…[1][2][3][4] Among the mechanistic pathway that mediates such effects, 4,5 elevated plasma levels of coagulation proteins such as factor VIII, von Willebrand factor, and fibrinogen, as well as shortened prothrombin time, have been associated with the exposure. [5][6][7][8] Recently, an association between particulate air pollution and an increased risk of deep vein thrombosis (DVT) was reported by some of us. 9 Determinants of arterial and venous thrombosis are in part different, as hypercoagulability due to a series of heritable or acquired risk factors, including the gain-of-function mutations in coagulation factor V (factor V Leiden) and prothrombin (prothrombin G20210A), deficiencies of the natural anticoagulant proteins antithrombin, protein C and protein S, and use of oral contraceptive or hormone replacement therapy, [10][11][12] is much more associated with venous than arterial thrombosis.…”