The von Willebrand Factor in Myocardial Infarction and Unstable Angina: A Kinetic Study

Margulis, T; David, Miriam; N, Maor; Soff, Gerald A.; Grenadier, Ehud; Palant, A; Aghai, E

doi:10.1055/s-0038-1661565

Cited by 29 publications

(11 citation statements)

References 4 publications

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“…Our data further confirm that patients with acute MI have increased vWF:RiCO levels 29 and demonstrate, probably for the first time, similar levels in non-STEMI and STEMI patients. Plasma levels of vWF:RiCO were correlated well with CADP-CT in the MI patients (rϭϪ0.65) of our study.…”

Section: Discussionsupporting

confidence: 85%

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

et al. 2004

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Background-Platelet activation is a hallmark of acute coronary syndromes. Numerous lines of evidence suggest a mechanistic link between von Willebrand factor or platelet hyperfunction and myocardial damage in patients with acute coronary syndromes. Thus, we assessed whether platelet function under high shear rates (collagen adenosine diphosphate closure times [CADP-CTs]) measured with the platelet function analyzer (PFA-100) may be enhanced in patients with myocardial infarction (MI) and whether it may predict the extent of myocardial damage as measured by creatine kinase (CK-MB) or troponin T (TnT) levels. Methods and Results-Patients with acute chest pain or symptoms suggestive of acute coronary syndromes (nϭ216) were prospectively examined at an emergency department. CADP-CT was significantly shorter in patients with MI, particularly in those with an ST-segment-elevation MI (STEMI) compared with the other patient groups (unstable angina, stable coronary artery disease, or controls). Furthermore, CADP-CT and collagen epinephrine-CT at presentation were independent predictors of myocardial damage as measured by CK-MB or TnT. Patients with MI whose CADP-CT values fell in the first quartile had 3-fold higher CK-MB and TnT levels than those in the fourth quartile. Conclusions-Patients with STEMI have significantly enhanced platelet function when measured under high shear rates.CADP-CT is an independent predictor of the severity of MI, as measured by markers of cardiac necrosis. Measurement of platelet function with the PFA-100 may help in the risk stratification of patients presenting with MI. (Circulation.

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Section: Discussionsupporting

confidence: 85%

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

et al. 2004

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“…Patients with AMI have increased VWF levels compared with patients with unstable angina pectoris. 79,90 Moreover, the extent of the VWF increase is an independent predictor of short-term adverse clinical outcome in patients with ACS (Table 2). [91][92][93][94] For instance, the extent of VWF release (ie, the difference between baseline and 24-hour VWF values during the index event), not only is associated with the incidence of acute heart failure but also is significantly correlated with 30-day mortality in patients with STEMI.…”

Section: Vwf and Acsmentioning

confidence: 99%

Von Willebrand Factor in Cardiovascular Disease

2008

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Abstract-von Willebrand factor (VWF) plays a pivotal role in platelet adhesion and aggregation at sites of high shear rates (eg, in coronary arteries that have stenotic or ruptured atherosclerotic plaque lesions). Numerous studies have investigated the relationship between VWF plasma levels and thromboembolic cardiovascular events. In contrast to the rather weak association in the general population, in patients with preexisting vascular disease, VWF is significantly predictive for adverse cardiac events, including death. Likewise, VWF typically rises during the course of acute coronary syndrome, and the extent of this VWF release is an independent predictor of adverse clinical outcome in these patients. Key Words: coronary disease Ⅲ myocardial infarction Ⅲ platelets Ⅲ thrombosis Ⅲ von Willebrand factor F or Ͼ150 years, it has been known that alterations in blood flow, vascular wall, and blood components, the so-called Virchow's triad, 1 may progressively lead to thrombus formation. Yet, a more complete understanding of the complex interactions among the vascular endothelium, platelet adhesion, activation, aggregation, and clotting factor activation involved in this process is still emerging from contemporary research.Under physiological conditions, the vascular endothelium produces many substances that contribute importantly to hemostasis, fibrinolysis, and regulation of vessel tone and permeability. One such substance is the multimeric glycoprotein von Willebrand factor (VWF), which is produced almost exclusively by endothelial cells. 2 Plasma levels of VWF are raised in different states of endothelial damage and have therefore been proposed as useful markers of endothelial dysfunction. 3 Along this line, blockade of nitric oxide enhances the stimulated release of VWF in humans. 4,5 Furthermore, VWF plays a crucial role in platelet adhesion and aggregation under high shear conditions. 6 Finally, VWF supports the third component of Virchow's triad, clotting factor activation, by acting as a carrier protein and stabilizer for factor VIII. 7 Almost all acute coronary syndromes (ACS) result from thrombus formation in preexisting coronary atherosclerosis. As a result of plaque rupture and exposure of prothrombotic subendothelial matrix, local thrombus formation occurs, which subsequently leads to coronary artery occlusion and acute myocardial infarction (AMI). The presence of VWF has been shown to play a pivotal role in platelet aggregation at sites of high shear, eg, at the sites of lesions in the coronary arteries. 8 Accordingly, VWF is a well-characterized marker of cardiovascular risk, and VWF plasma levels are increased in patients with ACS. 9 Considering the central role of VWF in thrombogenesis, therapies that specifically inhibit VWF are of particular interest as potential new antiplatelet drugs.

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“…Clinical studies further taught us that the critical role of VWF in haemostasis is not only obvious from the bleeding tendency that is associated with its functional deficiency, but also in view of its relationship with thrombotic disorders. Increased levels of VWF have been shown to be predictive for atherothrombotic complications 15–22. In line with VWF being a risk factor for atherothrombotic complication, a recent study reported a reduced prevalence of arterial thrombosis in patients with VWD 23.…”

Section: Introductionmentioning

confidence: 90%

On the Versatility of Von Willebrand Factor

Lenting¹

2013

Mediterr J Hematol Infect Dis

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Von Willebrand factor (VWF) is a large multimeric protein, the function of which has been demonstrated to be pivotal to the haemostatic system. Indeed, quantitative and/or qualitative abnormalities of VWF are associated with the bleeding disorder Von Willebrand disease (VWD). Moreover, increased plasma concentrations of VWF have been linked to an increased risk for thrombotic complications. In the previous decades, many studies have contributed to our understanding of how VWF is connected to the haemostatic system, particularly with regard to structure-function relationships. Interactive sites for important ligands of VWF (such as factor VIII, collagen, glycoprotein Ibα, integrin αIIbβ3 and protease ADAMTS13) have been identified, and mutagenesis studies have confirmed the physiological relevance of the interactions between VWF and these ligands. However, we have also become aware that VWF has a more versatile character than previously thought, given its potential role in various non-hemostatic processes, like intimal thickening, tumor cell apoptosis and inflammatory processes. In the presence review, a summary of our knowledge on VWF structure-function relationships is provided in the context of the “classical” haemostatic task of VWF and in perspective of pathological processes beyond haemostasis.

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The von Willebrand Factor in Myocardial Infarction and Unstable Angina: A Kinetic Study

Cited by 29 publications

References 4 publications

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

Von Willebrand Factor in Cardiovascular Disease

On the Versatility of Von Willebrand Factor

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