ROLE OF HEMOSTATIC RISK-FACTORS FOR RESTENOSIS IN PERIPHERAL ARTERIALOCCLUSIVE DISEASE AFTER TRANSLUMINAL ANGIOPLASTY

In a prospective study, the role of various hemostatic factors known t o be associated with thrombotic risk was investigated in 71 patients w ith peripheral arterial occlusive disease (PAOD, stages II through IV, Fontaine; aged 68 +/- 13 years). Laboratory investigations were done before; 1, 24, and 48 hours after; and 3 and 6 months after percutaneo us transluminal angioplasty (PTA). Thirty of 71 (42.3%) patients devel oped restenosis (>50% reduction of the lumen diameter) at the site of PTA within 6 months, verified by color-coded duplex sonography. Signif icantly increased levels of thrombin-antithrombin III complexes (P < . 01), prothrombin fragments 1 + 2 (P < .01), and D-dimers (P < .01) wer e found 1 hour, as well as 24 to 48 hours, after PTA. Fibrinogen (P < .01) and von Willebrand factor (P < .01) were significantly higher 48 hours after PTA. Restenotic patients as a whole had higher plasma fibr inogen (3.46 +/- 1.12 versus 2.95 +/- 0.62 g/L, P < .01) and C-reactiv e protein (25.4 +/- 46.7 versus 7.9 +/- 6.9 mg/L, P < .05) at baseline , as well as higher fibrinogen (P < .05) and prothrombin fragments 1 2 (P < .01) during months 3 to 6 after PTA. There was a nonsignifican t tendency for higher values of von Willebrand factor (206 +/- 98% ver sus 184 +/- 100%, P = .2) at baseline in patients with restenosis, whe reas tissue plasminogen activator, plasminogen activator inhibitor, co agulation screening tests, blood cell counts, and serum lipids showed no significant difference between the two groups. The relative risk fo r developing restenosis within 6 months while having high fibrinogen ( >2.8 g/L) or C-reactive protein at baseline was 2.80 (95% CI: 1.30-6.0 2, P < .01) and 1.96 (95% CI: 1.07-3.58, P < .05), respectively. Patie nts with critical limb ischemia (stage III/IV, Fontaine) had significa ntly higher fibrinogen and von Willebrand factor at repeated points of time, as well as significantly higher C-reactive protein and lower cr eatinine clearance at entry. In the logistic regression risk factor an alysis, baseline plasma fibrinogen, C-reactive protein concentration, and the severity of the arterial disease were significantly predictive of restenosis. Our results indicate that high procoagulant factors an d persistent thrombin generation of the hemostatic system might promot e restenosis, particularly in patients with extended atherosclerosis, This finding suggests that new treatment strategies should be taken un der consideration for patients with PAOD and PTA.