Coagulation activation and ultrasound characteristics in patients with carotid artery disease |
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Authors: | Tilo Kö lbel,Isabel Goncalves,Karin Strandberg,Anders Gottsä ter |
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Affiliation: | a Vascular Center, Malmö University Hospital, Malmö, Sweden b Department of Cardiology, Malmö University Hospital, Malmö, Sweden c Clinical Chemistry, Malmö University Hospital, Malmö, Sweden |
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Abstract: | IntroductionElevated levels of markers for thrombin activation are associated with plaque echogenicity and degree of stenosis in patients with carotid artery stenosis. The Activated Protein C-Protein C Inhibitor (APC-PCI) complex reflects activation of the Protein C system and is a measure of thrombin generation. The aim of the present study was to examine APC-PCI complex in patients undergoing thrombendartherectomy for carotid artery stenosis, and to relate the findings to clinical characteristics and plaque morphology as determined by ultrasound.Materials and MethodsBlood was obtained from 125 patients (39 female, median age 71 years) with carotid artery stenosis admitted from September 2005 to May 2007. The APC-PCI complex was measured using a sandwich immunofluorometric method and compared to an age- and sex-matched healthy control-group. Clinical and demographic characteristics, routine laboratory markers and ultrasound characteristics were analysed using univariate and multivariate analysis.ResultsAPC-PCI complex concentration was significantly increased in patients with carotid artery stenosis (median 0.21 µg/L; 10th to 90th percentile 0.15-0.36) compared to a healthy control-group (0.19 µg/L; 0.11-0.31; P = .009). There was no significant difference in APC-PCI-values between asymptomatic (n = 48) and symptomatic (n = 77) patients with carotid artery stenosis (0.22 vs. 0.20 µg/L; p = 0.626). Patients with minor stroke (n = 31) had a higher median APC-PCI-concentration (0.27 µg/L; 0.15-0.63) than patients with amaurosis fugax (0.19 µg/L; 0.15-0.36) or transient ischemic attack (0.21 µg/L; 0.12-0.36) (p = 0.016). No association was found between APC-PCI-values and the degrees of carotid artery stenosis or the time from the latest neurological symptoms to blood sampling. Patients with echolucent plaques had significantly lower APC-PCI concentrations (0.20 µg/L; 0.14-0.35 vs. 0.24 µg/L; 0.15-0.60; p = 0.043), according to the Gray-Weale classification.ConclusionsPatients with carotid artery disease exhibit increased concentrations of APC-PCI compared to a healthy control-group, particularly those patients with echogenic plaques, who have significantly higher APC-PCI levels than patients with echolucent plaques. |
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Keywords: | AAA, Abdominal aortic aneurysm ACE, Angiotensin converting enzyme APC, Activated protein C APC-PCI, Activated Protein C-Protein C Inhibitor complex BMI, Body mass index BP, Blood pressure CAD, Coronary artery disease COPD, Chronic obstructive pulmonary disease CVE, Cerebrovascular event DELFIA, Dissociation-enhanced lanthanide fluorescent immunoassay ECST, European carotid surgery trial F1 + 2, prothrombin fragment 1 + 2 HDL, High-density lipoprotein hs-CRP, High-sensitivity C-reactive protein ICA, Internal carotid artery LDL, Low-density lipoprotein PAD, Peripheral atherosclerotic disease PCI, Protein C inhibitor SWEDAC, Swedish board for accreditation and conformity assessment TAT, Thrombin-antithrombin complex TEA, Thrombendartherectomy TF, Tissue factor TFPI, Tissue factor pathway inhibitor TIA, Transient ischemic attack |
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