ASSOCIATION OF INCREASED FIBRIN TURNOVER AND DEFECTIVE FIBRINOLYTIC CAPACITY WITH LEG ATHEROSCLEROSIS

Patients with peripheral arterial disease have a high risk of death fr om cardiovascular events. As defective fibrinolysis associated with le g atherosclerosis has been suggested as a predisposing factor, we soug ht a relation among decreased fibrinolysis,the presence of leg atheros clerosis and the incidence of thrombotic events in a case-control stud y nested in the PLAT. Fifty-eight patients with coronary and/or cerebr al atherothrombotic disease, free of leg atherosclerosis at Doppler ex amination, were compared with 50 atherosclerotic patients with leg inv olvement. High D-dimer (153.0 vs 81.3 ng/ml, p <0.001) and tPA antigen before venous stasis (14.4 vs 11.8 ng/ml, p <0.03), and low tPA antig en (6.7 vs 15.6 ng/ml, p <0.01) and fibrinolytic activity released aft er venous stasis (fibrinolytic capacity: 113.2 vs 281.4 mm(2), p <0.00 1) were found in patients with leg atherosclerosis. D-dimer and fibrin olytic capacity, in addition to age, were selected by stepwise discrim inant analysis as characterizing patients with leg atherosclerosis. Mo reover, higher D-dimer and tPA inhibitor characterized patients with l eg atherosclerosis who subsequently experienced thrombotic events. The se findings constitute evidence of high fibrin turnover and impaired f ibrinolytic potential in patients with leg atherosclerosis. Thus impai red fibrinolysis may contribute to the prothrombotic state in these pa tients.