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Persistent global hypercoagulability in long-term survivors of acute pulmonary embolism

Chow, Vincenta; Reddel, Carolinea; Pennings, Gabriellea; Chung, Tommya; Ng, Austin C.C.a; Curnow, Jenniferb; Kritharides, Leonarda

Blood Coagulation & Fibrinolysis: July 2015 - Volume 26 - Issue 5 - p 537–544
doi: 10.1097/MBC.0000000000000285
ORIGINAL ARTICLES

Hypercoagulable and/or hypofibrinolytic states are risk factors for venous thromboembolism (VTE) including acute pulmonary embolism. Current screening for thrombophilia is targeted towards identifying a specific defect and guidelines recommend a population-based rather than individualized strategy for anticoagulation treatment. We investigated whether there is a global hypercoagulable state in long-term survivors of pulmonary embolism no longer receiving therapeutic anticoagulation utilizing the overall haemostatic potential (OHP) assay, which assesses overall coagulation potential (OCP), OHP and overall fibrinolytic potential (OFP). Long-term survivors of acute pulmonary embolism were identified from a local registry and OHP assays were performed and compared with age and sex-matched controls without pulmonary embolism. Time courses of fibrin formation and degradation were measured by spectrophotometry (absorption 405 nm) after addition of tissue factor and tissue plasminogen activator to plasma. OHP assays were performed in 67 long-term survivors of single pulmonary embolism (7.9 ± 1.4 years after pulmonary embolism) and 20 age (61.7 ± 11.2 vs 56.6 ± 6.4 years, P = 0.06) and sex (P = 0.45)-matched controls. Survivors of pulmonary embolism were more hypercoagulable as reflected by significantly higher OCP (56.4 ± 13.0 vs 49.9 ± 6.9, P = 0.03) and had impaired fibrinolysis with higher OHP (12.6 ± 7.0 vs 5.9 ± 2.0, P < 0.001) and lower OFP (78.1 ± 9.4 vs 88.2 ± 2.9, P < 0.001) compared with controls. Importantly, these abnormalities in overall coagulation were independently predicted by levels of fibrinogen, platelet count, shortened activated partial thromboplastin time and inflammatory markers suggesting a multifactorial cause. Long-term survivors of pulmonary embolism demonstrate enhanced global coagulation and reduced fibrinolytic potential. Assessment of global coagulation may provide new insights into the aggregate effects of multiple prothombotic factors and long-term risk of VTE recurrence.

aCardiology Department

bHaematology Department, Concord Hospital, The University of Sydney & The ANZAC Research Institute, Concord, New South Wales, Australia

Correspondence to Professor Leonard Kritharides, Cardiology Department, Concord Hospital, The University of Sydney & The ANZAC Research Institute, Level 3 West, Hospital Road, Concord, 2139 New South Wales, Australia Tel: +61 2 9767 6296; fax: +61 2 9767 6994; e-mail: leonard.kritharides@sydney.edu.au

Received 3 November, 2014

Revised 22 January, 2015

Accepted 3 February, 2015

Copyright © 2015 YEAR Wolters Kluwer Health, Inc. All rights reserved.