Activation products of the haemostatic system in coronary, cerebrovascularand peripheral arterial disease

To determine the presence of a 'hypercoagulable state' as assessed by indic es of thrombin and plasmin generation and of the amount of fibrin that is l ysed, in patients with stable coronary, cerebral and peripheral arterial di sease a population-based cross-sectional study was performed. From a popula tion-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients wi th peripheral arterial disease and 263 control subjects in the same age gro up without arterial disease. Subjects using anticoagulant drugs were not se lected. F1+2, TAT, and PAP were not associated with a history of cardiovasc ular events, nor with peripheral arterial disease. In contrast, positive as sociations were found for D-Dimer. Mean D-Dimer level was 40 mug/l (95% CI 35,44) in control subjects; 53 mug/l (47, 61) in those with a history of my ocardial infarction and 51 mug/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increas ing severity of peripheral atherosclerosis; a decrease in ankle/arm systoli c blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 mug/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion. the markers of onset of coagulat ion F1+2, TAT and PAP are not associated with the presence of arterial dise ase. but increased levels of these markers are necessary for the positive a ssociation between D-Dimer and arterial disease.