Markers of Hemostatic Activation in Affected Coronary Arteries during Angioplasty

Abstract

SummaryTo characterize the extent of early activation of the hemostatic system following angioplasty, we obtained blood samples from the involved coronary artery of 11 stable angina patients during the procedure and measured sensitive markers of thrombin formation (fibrino-peptide A, prothrombin fragment 1.2, and soluble fibrin) and of platelet activation ((3-thromboglobulin). Levels of hemostatic markers in venous blood obtained from 14 young individuals with low pretest probability for coronary artery disease were not significantly different from levels in venous blood or intracoronary samples obtained prior to angioplasty. Also, there was no translesional (proximal and distal to the lesion) gradient in any of the hemostatic markers before or after angioplasty in samples obtained between 18 and 21 min from the onset of the first balloon inflation. Furthermore, no significant difference was noted between angioplasty and postangioplasty intracoronary concentrations. We conclude that intracoronary hemostatic activation does not occur in the majority of patients during and immediately following coronary angioplasty when high doses of heparin and aspirin are administered.

Early changes in local hemostasis activation following percutaneous coronary intervention in stable angina patients: a comparison between drug-eluting and bare metal stents

“…The main finding of our study is a transient, significant increase in markers of local coagulation and fibrinolysis following balloon induced vascular injury, without a corresponding increase in platelet activation. This confirms previous studies showing that arterial wall injury caused by PCI triggers transient hemostatic activation, leading to localized thrombosis and distal embolisation, although data are not consistent [22][23][24][25]. There is a strong and early activation of the hemostatic system, possibly related to endothelium and atheromatous plaque disruption in response to balloon arterial wall trauma.…”

Determinants of rebound thrombin activity after cessation of heparin in patients undergoing coronary interventions

“…The results of the current study extend previous observations of thrombin activity in the coronary circulation during PCI [6,7,[9][10][11] to the hours after PCI, when heparin is discontinued in order to facilitate vascular sheath removal. The interval involved has been associated with an increased incidence of acute closure at the angioplasty site [2].…”

A Case of Acute Myocardial Infarction With Repetitive Stent Thrombosis During Emergent Percutaneous Coronary Intervention Transient Decrease in Antithrombin III Activity and Heparin Resistance

“…15,16) Thus, in the state of a transient decrease in AT-III activity, PCI with coronary stenting using heparin in patients with ACS has unfavorable effects. When we encounter heparin resistance and stent thrombosis during emergent PCI in the setting of ACS, we should consider that a transient decrease in AT-III activity may be one of the causes of the heparin resistance.…”