Prognostic role of hemostatic markers in acute coronary syndromes patients

Coronary thrombosis is an important determinant of prognosis in patients wi th acute coronary syndromes (ACS). However, the identification of patients at high-risk for progression of coronary thrombosis is difficult in part be cause we currently lack clinically meaningful laboratory methods for its de tection. The most pron-dsing approaches involve the measurement in plasma o f markers of fibrin formation and degradation. Thrombin activity, as reflec ted by plasma or urine concentrations of fibrinopeptide A, is increased in patients with ACS and is associated with adverse outcome. However, the use of fibrinopeptide A as a marker of fibrin formation is limited by the very short half-life of the compound, by artifact due to sample aquisition, and by extremely long turnaround times. To overcome these limitations, measurem ent of soluble fibrin has been proposed. We have recently explored the prog nostic value of a new fibrin-specific ELISA assay for soluble fibrin in pat ients with ACS and found that patients with highest levels had a twofold in creased risk of early and late cardiac events. Increases in plasma concentr ations of cross-linked fibrin degradation products (XL-FDPs), which reflect increased fibrin turn-over, are a marker of risk for complications of myoc ardial infarction. However, until recently, assays for XL-FDPs lacked speci ficity, because they did not distinguish between fibrin and fibrinogen degr adation products. Recently, fibrin-specific ELISAs have been described and a rapid whole blood assay for D-dimer has been developed. We recently valid ated the prognostic value of this whole blood agglutination assay in patien ts with ACS. The results suggest that: (1) the detection of significant activation of th e coagulation and/or fibrinolytic system may be important for rapid risk st ratification of patients with ACS; (2) patients with biochemical evidence o f ongoing coronary thrombosis may particularly benefit from aggressive anti thrombotic strategies; (3) sequential measurements of these markers may be useful to guide antithrombotic treatment during the unstable phase of coron ary artery disease. (C) 2001 Elsevier Science BN. All rights reserved.