Predictive value of coagulation markers concerning clinical outcome 90 days after anterior myocardial infarction

To study the predictive value of coagulation markers concerning clinical ou tcome, prothrombin fragment F1.2 (F1.2), fibrin monomer antigen (FM), D-Dim er (DD), and fibrinogen were measured in plasma samples drawn 2 and 7 days after acute myocardial infarction (AMI) in 314 consecutive patients randomi zed in a clinical trial of low molecular weight heparin (Dalteparin) (the F RAMI trial). Placebo treated patients suffering death or new AMI within 90 days had significantly higher levels at day 2 of FM (Enzymun-Test FM), and DD (TINAquant D-dimer) (p = 0.001 and 0.02, respectively), but not F1.2 (En zygnost F1.2 micro), relative to those without serious clinical events. At day 7 all three coagulation activation markers were significantly higher in patients with subsequent adverse clinical outcome. The Dalteparin group ha d significantly lower levels of these markers as compared to the placebo gr oup. Left ventricular (LV) thrombus formation was not associated with chang es in coagulation activation. However, patients with thrombus had significa ntly higher fibrinogen levels than those without thrombus (p = 0.004 day 2) , independent of treatment group. Thus, markers of coagulation activation m ay be useful in stratification of patients when estimating risk for adverse clinical outcome after AMI. Furthermore, elevated fibrinogen levels are as sociated with increased risk of LV thrombus formation.