Plasma fibrin clot properties in atopic dermatitis: links between thrombosis and atopy

Abstract

Myocardial infarction and ischemic stroke are associated with formation of dense fibrin clots resistant to lysis. Although pro- and antithrombotic alterations have been reported in atopy, fibrin clot function has not been studied in atopic patients. The aim of the current study was to investigate fibrin clot properties in patients with atopic dermatitis (AD). Plasma fibrin clot permeability, turbidity and clot lysis were assessed in 130 consecutive AD patients, aged 29.7 +/- 11 [+/-SD] years (mean SCORAD index, 32.4 +/- 14.9), free of thrombotic events. A control group comprised 130 healthy controls matched for demographics. Patients with AD had lower clot permeability (7.12 +/- 1.87 vs. 9.32 +/- 0.86 x 10(-9) cm(2); P < 0.0001), increased fiber thickness (maximum clot absorbancy at 405 nm, 4.03 +/- 0.54 vs. 3.47 +/- 0.25), faster clot formation (the lag phase, 39.16 +/- 4.61 vs. 43.05 +/- 4.56 s), higher maximum D-dimer levels released from clots, reflecting increased clot mass (4.05 +/- 0.57 vs. 3.47 +/- 0.25 mg/l; P < 0.0001), lower rate of D-dimer release (0.073 +/- 0.01 vs. 0.078 +/- 0.01 mg/l/min; P < 0.0001), and prolonged fibrinolysis time (9.26 +/- 1.47 vs. 7.81 +/- 1.17 min; P < 0.0001) compared with controls. Concomitant asthma (n = 36; 27.7%) was related to a higher rate of D-dimer release from clots than the remainder (0.075 +/- 0.01 vs. 0.072 +/- 0.01 mg/l/min, respectively; P = 0.03). Altered plasma fibrin clot properties associated with reduced efficiency of fibrinolysis can be detected in AD patients, which might represent a novel mechanism that modulates a hemostatic balance in atopy.

Filaggrin loss‐of‐function mutations as risk factors for ischemic stroke in the general population

“…Another possible explanation for the association between FLG mutations and higher risk of ischemic stroke could be a general state of low-grade inflammation or changes in the coagulation system in individuals with atopic dermatitis [26][27][28]; however, we did not find an association between FLG mutation status and plasma concentrations of CRP, APTT or coagulation factors II-VII-X.…”

Interactions between Inflammation and Coagulation in Autoimmune and Immune-Mediated Skin Diseases

“…It has also been shown that eosinophils express tissue factor, the main initiator of blood coagulation, in erythrodermic lesional skin together with increased plasma levels of coagulation activation markers [19]. These findings indicate a prothrombotic state in AD patients and are in agreement with the findings of Nastalek et al who demonstrated altered plasma fibrin clot properties associated with a reduction in the efficiency of fibrinolysis [35]. However, the clinical relevance of these observations may be weakened by the fact that atopic subjects are usually young and thus at low risk of thrombotic events.…”

Association between atopic diseases and venous thromboembolism: a case–control study in patients aged 45 years or less

“…It is unknown whether allergic diseases, including common atopic disorders such as allergic rhinitis (AR), allergic asthma and atopic dermatitis (AD), are associated with thrombosis. Recently, we have reported that denser fibrin clot formation associated with reduced plasminmediated lysis can be detected in AD patients [5]. Given the data showing that venous thromboembolism (VTE) [6] is associated with the formation of dense fibrin clots resistant to lysis, unfavorably altered fibrin clot properties might constitute a prothrombotic mechanism that operates in atopy.…”

“…Tissue factor (TF) is the prime initiator of blood coagulation, and precise regulation of its production and activation is vital for normal hemostasis. DM2 patients have elevated plasma TF antigen [4] and TF procoagulant activity [5]. There is increased TF expression in circulating monocytes [6] and microparticles [7].…”