Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography

A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis

Kevin P. Bliden, Udaya S. Tantry, Martin G. Gesheff, Christopher J. Franzese, Shachi Pandya, Peter P. Toth, Denny P. Mathew, Rahul Chaudhary, Paul A. Gurbel

Research output: Contribution to journalArticle

Abstract

Background and Objective In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. We aimed to simultaneously assess thrombosis biomarkers and lipid levels in patients with and without ISR. Methods Consecutive patients (n = 170) with a history of coronary stenting undergoing elective angiography were studied. Blood samples for thrombelastography, light transmittance aggregometry, and lipid levels were obtained prior to cardiac catheterization. Results Sixty-nine patients (41%) had ISR (>50% luminal diameter stenosis). Among patients with ISR, 40 (58%) had ISR in more than one stent bed. Patients with ISR were more often female (37.7% vs. 21.8%, P = 0.04), had higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9 mm vs. 65.6 mm, P <0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, P = 0.03). In patients on dual antiplatelet therapy (n = 86), there were no differences in ADP-, arachidonic acid-, and collagen-induced platelet aggregation between groups. The frequency of patients with ISR increased with TIP-FCS quartiles and by ROC analysis, TIP-FCS = 67.0 mm was the cutpoint for identification of ISR (AUC = 0.80 (95%CI 0.73-0.87, P <0.0001). By multivariate analysis, TIP-FCS ≥67.0 mm strongly associated with ISR (OR = 7.3, P = 0.004). Conclusion Patients with ISR identified at the time of cardiac catheterization have a prothrombotic phenotype indicated by high TIP-FCS, a novel marker. Studies to confirm the prognostic utility of high TIP-FCS for the development of ISR are ongoing. (J Interven Cardiol 2016;29:168-178)

Original languageEnglish (US)
Pages (from-to)168-178
Number of pages11
JournalJournal of Interventional Cardiology
Volume29
Issue number2
DOIs
StatePublished - Apr 1 2016

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Thrombelastography
Fibrin
Thrombin
Stents
Coronary Vessels
Blood Platelets
Cardiac Catheterization
Lipids
Apolipoproteins B
Percutaneous Coronary Intervention
Platelet Aggregation
Arachidonic Acid
ROC Curve
Adenosine Diphosphate
Area Under Curve
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography : A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis. / Bliden, Kevin P.; Tantry, Udaya S.; Gesheff, Martin G.; Franzese, Christopher J.; Pandya, Shachi; Toth, Peter P.; Mathew, Denny P.; Chaudhary, Rahul; Gurbel, Paul A.

In: Journal of Interventional Cardiology, Vol. 29, No. 2, 01.04.2016, p. 168-178.

Research output: Contribution to journalArticle

Bliden, KP, Tantry, US, Gesheff, MG, Franzese, CJ, Pandya, S, Toth, PP, Mathew, DP, Chaudhary, R & Gurbel, PA 2016, 'Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography: A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis', Journal of Interventional Cardiology, vol. 29, no. 2, pp. 168-178. https://doi.org/10.1111/joic.12277
Bliden, Kevin P. ; Tantry, Udaya S. ; Gesheff, Martin G. ; Franzese, Christopher J. ; Pandya, Shachi ; Toth, Peter P. ; Mathew, Denny P. ; Chaudhary, Rahul ; Gurbel, Paul A. / Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography : A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis. In: Journal of Interventional Cardiology. 2016 ; Vol. 29, No. 2. pp. 168-178.
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abstract = "Background and Objective In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. We aimed to simultaneously assess thrombosis biomarkers and lipid levels in patients with and without ISR. Methods Consecutive patients (n = 170) with a history of coronary stenting undergoing elective angiography were studied. Blood samples for thrombelastography, light transmittance aggregometry, and lipid levels were obtained prior to cardiac catheterization. Results Sixty-nine patients (41{\%}) had ISR (>50{\%} luminal diameter stenosis). Among patients with ISR, 40 (58{\%}) had ISR in more than one stent bed. Patients with ISR were more often female (37.7{\%} vs. 21.8{\%}, P = 0.04), had higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9 mm vs. 65.6 mm, P <0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, P = 0.03). In patients on dual antiplatelet therapy (n = 86), there were no differences in ADP-, arachidonic acid-, and collagen-induced platelet aggregation between groups. The frequency of patients with ISR increased with TIP-FCS quartiles and by ROC analysis, TIP-FCS = 67.0 mm was the cutpoint for identification of ISR (AUC = 0.80 (95{\%}CI 0.73-0.87, P <0.0001). By multivariate analysis, TIP-FCS ≥67.0 mm strongly associated with ISR (OR = 7.3, P = 0.004). Conclusion Patients with ISR identified at the time of cardiac catheterization have a prothrombotic phenotype indicated by high TIP-FCS, a novel marker. Studies to confirm the prognostic utility of high TIP-FCS for the development of ISR are ongoing. (J Interven Cardiol 2016;29:168-178)",
author = "Bliden, {Kevin P.} and Tantry, {Udaya S.} and Gesheff, {Martin G.} and Franzese, {Christopher J.} and Shachi Pandya and Toth, {Peter P.} and Mathew, {Denny P.} and Rahul Chaudhary and Gurbel, {Paul A.}",
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T1 - Thrombin-Induced Platelet-Fibrin Clot Strength Identified by Thrombelastography

T2 - A Novel Prothrombotic Marker of Coronary Artery Stent Restenosis

AU - Bliden, Kevin P.

AU - Tantry, Udaya S.

AU - Gesheff, Martin G.

AU - Franzese, Christopher J.

AU - Pandya, Shachi

AU - Toth, Peter P.

AU - Mathew, Denny P.

AU - Chaudhary, Rahul

AU - Gurbel, Paul A.

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N2 - Background and Objective In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. We aimed to simultaneously assess thrombosis biomarkers and lipid levels in patients with and without ISR. Methods Consecutive patients (n = 170) with a history of coronary stenting undergoing elective angiography were studied. Blood samples for thrombelastography, light transmittance aggregometry, and lipid levels were obtained prior to cardiac catheterization. Results Sixty-nine patients (41%) had ISR (>50% luminal diameter stenosis). Among patients with ISR, 40 (58%) had ISR in more than one stent bed. Patients with ISR were more often female (37.7% vs. 21.8%, P = 0.04), had higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9 mm vs. 65.6 mm, P <0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, P = 0.03). In patients on dual antiplatelet therapy (n = 86), there were no differences in ADP-, arachidonic acid-, and collagen-induced platelet aggregation between groups. The frequency of patients with ISR increased with TIP-FCS quartiles and by ROC analysis, TIP-FCS = 67.0 mm was the cutpoint for identification of ISR (AUC = 0.80 (95%CI 0.73-0.87, P <0.0001). By multivariate analysis, TIP-FCS ≥67.0 mm strongly associated with ISR (OR = 7.3, P = 0.004). Conclusion Patients with ISR identified at the time of cardiac catheterization have a prothrombotic phenotype indicated by high TIP-FCS, a novel marker. Studies to confirm the prognostic utility of high TIP-FCS for the development of ISR are ongoing. (J Interven Cardiol 2016;29:168-178)

AB - Background and Objective In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. We aimed to simultaneously assess thrombosis biomarkers and lipid levels in patients with and without ISR. Methods Consecutive patients (n = 170) with a history of coronary stenting undergoing elective angiography were studied. Blood samples for thrombelastography, light transmittance aggregometry, and lipid levels were obtained prior to cardiac catheterization. Results Sixty-nine patients (41%) had ISR (>50% luminal diameter stenosis). Among patients with ISR, 40 (58%) had ISR in more than one stent bed. Patients with ISR were more often female (37.7% vs. 21.8%, P = 0.04), had higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9 mm vs. 65.6 mm, P <0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, P = 0.03). In patients on dual antiplatelet therapy (n = 86), there were no differences in ADP-, arachidonic acid-, and collagen-induced platelet aggregation between groups. The frequency of patients with ISR increased with TIP-FCS quartiles and by ROC analysis, TIP-FCS = 67.0 mm was the cutpoint for identification of ISR (AUC = 0.80 (95%CI 0.73-0.87, P <0.0001). By multivariate analysis, TIP-FCS ≥67.0 mm strongly associated with ISR (OR = 7.3, P = 0.004). Conclusion Patients with ISR identified at the time of cardiac catheterization have a prothrombotic phenotype indicated by high TIP-FCS, a novel marker. Studies to confirm the prognostic utility of high TIP-FCS for the development of ISR are ongoing. (J Interven Cardiol 2016;29:168-178)

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