Systemic and translesional activation of coagulation, fibrinolytic, and inhibitory systems in candidates for coronary angioplasty: Basal state and effect of successful dilation

Objectives Thrombosis is a major contributor to complications associated wi th coronary interventions. It is unclear whether patients who have undergon e angioplasty are predisposed to thrombus formation because of underlying p erturbations in their hemostatic equilibrium. Methods concentration or activity was measured for 14 plasma proteins invol ved in the coagulation, fibrinolytic, and inhibitory systems. Baseline syst emic measurements were compared between patients undergoing balloon angiopl asty (n = 15) and normal subjects (n = 32), with sampling repeated at the e nd of the procedure. To better assess the local hemo static environment nea r the site of dilation, intracoronary arterial samples were also obtained j ust proximal and distal to the dilated stenosis. Results Multiple differences in measured coagulation proteins were found at baseline between the angioplasty candidates and control subjects, includin g higher mean concentration of plasma fibrinogen (P <.001) and lower high-m olecular-weight kininogen concentration (P <.01) and factor XII activity (P <.01). concentrations of the inhibitory proteins antithrombin III and prot ein S also differed significantly (P <.001 and P <.01, respectively), with a trend toward lower protein C concentration as well (P <.05). Finally, hei ghtened fibrinolysis was suggested by a marked increase in mean plasma D-di mer concentration in the angioplasty candidates (293 +/- 191 ng/mL vs 116 /- 31 ng/mL, P <.01), with a more modest increase in tissue plasminogen act ivator (P <.05) and decrease in alpha(2)-antiplasmin (P <.001). Importantly , none of the parameters obtained during the procedure differed significant ly from samples obtained before and after angioplasty, and no translesional gradients were observed. Conclusions Patients with active ischemic syndromes who are considered cand idates for coronary angioplasty demonstrate significant and multiple altera tions in their coagulation, inhibitory, and fibrinolytic systems. However, no further changes were observed during coronary dilation, either systemica lly or locally, after pretreatment with typical doses of heparin and aspiri n.