Renal transplant recipients with coronary artery disease exhibit impairment in fibrinolysis and structural changes in carotid arteries

Abstract

Summary Cardiovascular disease (CVD) is the main cause of mortality and morbidity among kidney transplant recipients (Tx). Intima‐media thickness (IMT) of the common carotid artery is related to CVD. Hemostatic disturbances may contribute to the CVD pathogenesis in Tx. The aim of the study was to evaluate some hemostatic factors in Tx with and without coronary artery disease (CAD) and their correlations with IMT. Patients with CAD were significantly older, with thicker IMT, lower plasmin–antiplasmin complexes (PAP), higher fibrinogen, cholesterol, triglycerides, Thrombin‐activatable fibrinolysis inhibitor (TAFI) antigen and activity, prolonged euglobulin clot lysis time when compared to those without CAD. Kidney transplant recipients have higher mean blood pressure, serum lipids, fibrinogen, TAFI antigen, TAFI activity, markers of coagulation and fibrinolysis, thicker IMT and lower PAP relative to healthy volunteers. In univariate analysis, IMT correlated significantly with age, time on dialysis prior to transplantation, PAP, fibrinogen, hematocrit, body mass index (BMI). Multiple regression analysis showed that only age, hematocrit, PAP, and time on dialysis prior to transplantation were positive independent predictors of IMT. Hypofibrinolysis may contribute to the arterial remodeling in Tx. Dialysis therapy before transplantation makes detrimental changes in arterial vasculature.

Fibrin clot properties in coronary artery disease: new determinants and prognostic markers

“…This was supported by similar results in both stable CAD vs healthy controls [69][70][71] and in renal and cardiac transplant patients with CAD who had longer lysis times [72] and lower % lysis [73] than their peers with no CAD.…”

“…↑ in CAD vs healthy controls [69,70] and renal transplant patients with CAD vs no CAD [72] ↔ in CAD vs healthy controls [93] % lysis, fibrin plate:…”

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome

“…TAFI levels in plasma are reported to increase the risk of acute CAD almost four-fold [33] and are reported to increase in patients undergoing coronary artery bypass grafting [34]. In another study TAFI antigen levels and activity were reported to be higher in patients with CAD compared with those without CAD in kidney transplant recipients [35].…”

Elevated Thrombin Activatable Fibrinolysis Inhibitor (TAFI) Antigen Levels in Overt and Subclinical Hypothyroid Patients Were Reduced by Levothyroxine Replacement

“…High plasma levels of TAFI were found in patients with stable angina pectoris and angiographically verified coronary artery disease [11,22,23]. Malyszko et al [24] showed that renal transplant recipients with coronary artery disease had significantly elevated TAFI antigen concentrations and activity when compared to patients without coronary artery disease. In another study, increased TAFI activity was associated with an almost fourfold higher risk of coronary artery disease [25].…”