INCREASED FIBRIN TURNOVER AND HIGH PAI-1 ACTIVITY AS PREDICTORS OF ISCHEMIC EVENTS IN ATHEROSCLEROTIC PATIENTS - A CASE-CONTROL STUDY

A case-control comparison within the framework of the prospective, mul tidisciplinary PLAT Study was performed to assess whether altered base line fibrinolytic variables were associated with an elevated risk of i schemic thrombotic events in patients with documented coronary, cerebr al, and/or peripheral atherosclerotic disease. Fibrinogen, D-dimer, ti ssue plasminogen activator (t-PA) antigen, and fibrinolytic activity b efore and after venous stasis (DELTA=difference between the two values ), t-PA inhibitor, and lipid levels in 60 atherosclerotic patients wit h a thrombotic event during the first year of follow-up were compared with those in 94 atherosclerotic patients without such events, who wer e matched for age, sex, and diagnosis at enrollment. Events were assoc iated with a higher release of DELTA t-PA antigen (P=.047), higher D-d imer (P=.024), and higher t-PA inhibitor (P=.001) levels. DELTA Fibrin olytic activity was correlated inversely with t-PA inhibitor (P<.01) a nd triglycerides (P<.05). D-Dimer was also correlated with systolic bl ood pressure (P<.01). Atherosclerotic patients at higher risk of throm botic ischemic events are characterized by increased fibrin turnover a nd impaired fibrinolytic activity due to high t-PA inhibitor levels. T his hemostatic disequilibrium may participate with conventional risk f actors such as elevated triglyceride levels and systolic blood pressur e in the multifactorial mechanism of ischemic sequelae in patients wit h preexisting vascular atherothrombotic disease.