Original articles

Factors influencing thrombin generation measured as thrombin-antithrombin complexes levels and using calibrated automated thrombogram in patients with advanced coronary artery disease

Ewa Stępień, Dariusz Plicner, Agnieszka Branicka, Elżbieta Stankiewicz, Agnieszka Pazdan, Maria Śnieżek-Maciejewska, Izabela Górkiewicz, Bogusław Kapelak, Jerzy Sadowski
Published online: July 01, 2007
Introduction. Haemostatic factors play an important role in atherothrombosis. Thrombin generation is a crucial stage of blood coagulation. Objectives. Comparison of different thrombin generation markers: thrombin-antithrombin complex (TAT) generation and calibrated automated thrombogram method (CAT). Identification of factors influencing thrombin generation in patients with stable angina (SA) enrolled to the coronary artery bypass grafting (CABG) surgery. Analysis of traditional (age, gender, hypertension and diabetes) and novel (fibrinogen and C-reactive protein [CRP]) risk factors and the antiplatelet therapy (aspirin 75–150 mg/d) in relation to coagulation. Patients and methods. In 135 SA patients with left main coronary artery stenosis (>50%) or major epicardial artery stenosis (>70%), plasma TAT levels, maximal thrombin concentration (Cmax) and endogenous thrombin potential (ETP) were determined. A marker of the platelet activation (β-thromboglobulin) was also measured. Results. No correlations among TAT, Cmax, ETP, risk factors and β-thromboglobulin were observed. Linear regression model showed that independent predictors of TAT levels were age (β = 0.5; p = <0.0001), male gender and diabetes (β = 0.36; p = 0.02). CRP independently predicted TAT and ETP (β = –0.24 and β = 0.22; p <0.05, respectively), while fibrinogen predicted Cmax (β = 0.21; p <0.05). Independent predictors of β-thromboglobulin were a male gender and aspirin use cessation (β = 0.46; p = 0.01). Aspirin treatment had no effect on thrombin generation. Conclusions. Age, higher fibrinogen, CRP, diabetes and male gender influence thrombin generation and/or coagulation activation in SA patients. Plasma levels of thrombin-antithrombin complexes do not correlate with the parameters obtained using the calibrated automated thrombogram method (Cmax, ETP).

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