Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

Abstract

Background Coagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. In this study we aimed to assess the coagulation and platelet state in IE implementing a wide range of standard and global laboratory assays. We also aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients. Methods 37 patients with IE were enrolled into the study. Coagulation was assessed using standard coagulation assays (activated partial thromboplastin time (APTT), prothrombin, fibrinogen, D-dimer concentrations) and integral assays (thromboelastography (TEG) and thrombodynamics (TD)). Platelet functional activity was estimated by flow cytometry. Single nuclear polymorphisms of coagulation system genes were studied. Results Fibrinogen concentration and fibrinogen-dependent parameters of TEG and TD were increased in patients indicating systemic inflammation. In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation. However, in some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation. Resting platelets were characterized by glycoprotein IIb-IIIa activation and degranulation. In patients with fatal IE, we observed a significant decrease in fibrinogen and thrombodynamics. In patients with embolism, we observed a significant decrease in the TEG R parameter. No association of embolism or mortality with genetic polymorphisms was found in our cohort. Conclusions Our findings suggest that coagulation in patients with infective endocarditis is characterized by general hypercoagulability and platelet pre-activation. Some patients, however, have hypocoagulant coagulation profile, which presumably can indicate progressing of hypercoagulation into consumption coagulopathy.

Patients with infective endocarditis undergoing cardiac surgery have distinct ROTEM profiles and more bleeding complications compared to patients without infective endocarditis

“…In very severe cases, however, hypocoagulable profiles were documented (interpreted by the authors as progression into consumption coagulopathy), whereas patients developing thromboembolic complications displayed a decreased R parameter, which is analogous to clotting time in ROTEM. Thus, in general, our findings are similar to those by Koltsova et al, concerning hypercoagulopathic patterns in patients with IE [ 21 ]. The differences between patients with and without IE, however, were more pronounced in our study.…”

“…displayed a decreased R parameter, which is analogous to clotting time in ROTEM. Thus, in general, our findings are similar to those by Koltsova et al, concerning hypercoagulopathic patterns in patients with IE [21]. The differences between patients with and without IE, however, were more pronounced in our study.…”

“…In a recent study on conservatively treated patients with IE [ 21 ], coagulation status was assessed by thromboelastography (TEG) and classical laboratory parameters. The authors found an increase in D-dimer and fibrinogen concentration in IE patients, while TEG parameters were not different to those from healthy volunteers.…”

Study of the Significance of Thromboelastography Changes in Patients with Dyslipidemia

“…Routine coagulation functions such as PT and APTT mainly target a certain stage and segment of the coagulation process and do not reflect the whole thrombosis process well. It has limited accuracy in determining hemostatic function and predicting bleeding risk in patients with important diseases and does not allow obtaining clot strength and clot stability, as these tests are detected at the beginning of the fibrin polymerization process when only about 5% of thrombin is produced and cannot evaluate the relationship between platelets and fibrinogen due to the inability to evaluate the relevant platelet function, fibrinolysis, and hypercoagulable state [ 17 , 18 ]. The mechanism of TEG is based on the entire coagulation process from clotting to fibrinolysis, reflecting the interaction between the elements, with the end result being the formation of a blood clot whose physical properties determine whether the patient has normal coagulation [ 19 ].…”

Transfusion of blood products in cardiac surgery for endocarditis: predictors and consequences

“…Moreover, elevated fibrinogen levels are often documented in the acute phase of infection and inflammation (Grottke et al, 2020). This hypercoagulable state has been observed through laboratory parameters (Koltsova et al, 2021). A viscoelastic testing by rotational thromboelastometry can be used to direct preoperative supplementation of fibrinogen in patients with IE needing cardiac reoperation.…”