Fibrin D-Dimer, Haemostatic Factors and Peripheral Arterial Disease

Lee, A. J.; Fowkes, F. Gerry R.; Lowe, G. D. O.; Rumley, Ann

doi:10.1055/s-0038-1649831

Cited by 79 publications

(52 citation statements)

References 25 publications

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“…First, D-dimer levels may be sensitive measures of the systemic atherosclerotic burden. 3,4 Greater atherosclerotic burden may be associated with more functional impairment. Second, D-dimer has been shown to induce the synthesis and release of inflammatory cytokines interleukin (IL)-6 and IL-1␤.…”

Section: Discussionmentioning

confidence: 99%

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D-Dimer, Inflammatory Markers, and Lower Extremity Functioning in Patients With and Without Peripheral Arterial Disease

et al. 2003

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Background-We determined whether higher levels of D-dimer, C-reactive protein (CRP), fibrinogen, and serum amyloid A are associated independently with functional impairment in patients with and without peripheral arterial disease (PAD). Methods and Results-Participants were 370 men and women with PAD (ankle brachial index Ͻ0.90) and 231 without PAD. Functional outcomes were 6-minute walk distance and 4-meter walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for 5 repeated chair rises into an ordinal score ranging from 0 to 12 (12ϭbest). Adjusting for age, sex, ankle brachial index, comorbidities, and other potential mediators and confounders, D-dimer levels were associated independently and inversely with performance on all 3 functional measures in the entire cohort and among patients with and without PAD, respectively. Adjusting for known and potential confounders, CRP levels were associated independently with 6-minute walk distance and the summary performance score among participants with PAD. No significant associations were observed between CRP and the functional measures among participants without PAD. Fibrinogen and SAA levels were not associated independently with the functional measures. Conclusions-Higher D-dimer levels are associated with poorer functioning among individuals with and without PAD.Higher CRP levels were associated with poorer 6-minute walk performance and a lower summary performance score among participants with PAD but not among those without PAD. Additional study is needed to determine whether D-dimer and CRP are involved in the pathophysiology of functional impairment or whether they are simply sensitive markers of the extent of systemic atherosclerosis. (Circulation. 2003;107:3191-3198.)Key Words: coagulation Ⅲ fibrinolysis Ⅲ epidemiology Ⅲ peripheral vascular disease Ⅲ claudication M echanisms of functional impairment in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. Greater lower extremity arterial obstruction, as measured by the ankle brachial index (ABI), is associated with greater functional impairment. 1,2 However, to our knowledge, associations between hemostatic or inflammatory markers with lower extremity functioning have not been assessed previously in persons with and without PAD.Increased levels of D-dimer and inflammatory markers may be associated with functional impairment because they are sensitive measures of the burden of lower extremity and systemic atherosclerosis. D-dimer levels may reflect atherosclerosis severity, because D-dimer is a marker of ongoing fibrin formation and degradation. [3][4][5] Inflammatory markers may also be measures of the extent of atherosclerotic activity. 6,7 Alternatively, increased levels of inflammation may weaken muscles, thereby impairing lower extremity functioning. 8,9 We determined associations of D-dimer and 3 inflammatory markers (C reactive protein [CRP], fibrinogen, and serum amyloid A [SAA]) with lower extremity functionin...

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Section: Discussionmentioning

confidence: 99%

“…D-dimer levels may reflect atherosclerosis severity, because D-dimer is a marker of ongoing fibrin formation and degradation. [3][4][5] Inflammatory markers may also be measures of the extent of atherosclerotic activity. 6,7 Alternatively, increased levels of inflammation may weaken muscles, thereby impairing lower extremity functioning.…”

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confidence: 99%

D-Dimer, Inflammatory Markers, and Lower Extremity Functioning in Patients With and Without Peripheral Arterial Disease

et al. 2003

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“…31 Fibrin D-dimer levels are elevated in patients with established atherothrombotic vascular disease 32,33 and predict arterial thrombotic events in prospective studies involving healthy, middle-aged subjects. 2,5,10 -12 It is possible that D-dimer levels merely reflect the underlying fibrinogen concentration; however, in the Caerphilly Study, adjustment for other CAD risk factors including fibrinogen did not affect the independent relationship between elevated D-dimer levels and the relative risk of CAD events.…”

Section: Fibrin D-dimermentioning

confidence: 99%

Tissue Plasminogen Activator, Fibrin D-Dimer, and Insulin Resistance in the Relatives of Patients With Premature Coronary Artery Disease

Mills

Mansfield

Grant

2002

ATVB

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Abstract-Elevated levels of tissue-type plasminogen activator antigen (tPA), fibrinogen, and fibrin D-dimer predict coronary artery disease (CAD) events and stroke. These factors, possibly in association with insulin resistance, may be important in families in which CAD has become clinically apparent at a premature age. From 125 patients with angiographically confirmed, premature CAD, 175 healthy male relatives (age Յ65 years) were identified. One hundred seventy-five healthy volunteers of similar age and without any family history of CAD were recruited. There were no differences between relatives and controls in terms of conventional CAD risk factors, cigarette smoking, alcohol consumption, or cardiorespiratory fitness. Estimated insulin resistance and plasminogen activator inhibitor 1 levels were not increased in relatives. Fibrin D-dimer, tPA, and fibrinogen levels were elevated in relatives compared with controls, 55 (52 to 58) ng/mL versus 49 (45 to 53) ng/mL, PϽ0.01, for D-dimer; 8.0 (7.5 to 8.6) ng/mL versus 5.6 (5.2 to 6.1) ng/mL, PϽ0.001, for tPA; and 3.0 (2.9 to 3.1) g/L versus 2.8 (2.7 to 2.9) g/L, PϽ0.05, for fibrinogen. These differences remained after adjustment for correlates, including fibrinogen, age for D-dimer, and features of the insulin resistance syndrome for tPA. tPA and D-dimer levels are elevated in the healthy, male, first-degree relatives of patients with premature CAD. This association is independent of potential confounding factors.

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“…11 In addition, D-dimer influences inflammatory and acute-phase responses by promoting neutrophil and monocyte activation, inflammatory cytokine secretion, and hepatic production of acute-phase proteins.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease

et al. 2004

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Men and women with lower extremity peripheral arterial disease (PAD) have reduced physical activity levels compared with persons without PAD. We describe associations between physical activity levels with D-dimer, pro-coagulant factors, and inflammatory markers in patients with PAD. Participants were188 patients with PAD identified from non-invasive vascular laboratories. Physical activity was measured over 7 days with a vertical accelerometer. We measured the ankleÀbrachial index (ABI) and levels of D-dimer, C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA), prothrombin 1.2, t-PA antigen, PAI-1, and the t-PA antigen=PAI-1 ratio. Adjusting for age, sex, race, body mass index, ABI, comorbidities, smoking, total cholesterol=HDL ratio and statin use (for CRP only), we found significant inverse linear associations between physical activity levels and log D-dimer (p ¼ 0.002), log CRP (p < 0.001), fibrinogen (p ¼ 0.014), and log SAA (p ¼ 0.012). There were no significant associations between physical activity levels and other blood factors. In an analysis adjusting for all blood factors simultaneously along with known and potential confounders, log D-dimer was the only blood factor associated significantly with physical activity levels (p ¼ 0.036). Based on these findings, future studies should assess whether interventions to increase physical activity in patients with PAD reduce levels of D-dimer and inflammatory markers.

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Fibrin D-Dimer, Haemostatic Factors and Peripheral Arterial Disease

Cited by 79 publications

References 25 publications

D-Dimer, Inflammatory Markers, and Lower Extremity Functioning in Patients With and Without Peripheral Arterial Disease

D-Dimer, Inflammatory Markers, and Lower Extremity Functioning in Patients With and Without Peripheral Arterial Disease

Tissue Plasminogen Activator, Fibrin D-Dimer, and Insulin Resistance in the Relatives of Patients With Premature Coronary Artery Disease

Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease

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