Identities of procoagulant changes of hemostasis in patients with chronic peripheral arterial occlusive disease
Russian Research Institute of Hematology and Transfusiology, St. Petersburg, Russia
Arterial thrombosis as well as its complications is currently one of the main causes of mortality and disability in civilized countries. That?s why the studies directed toward the improvement of thrombosis diagnostics and treatment in patients with chronic peripheral arterial occlusive diseases (CPAOD) are of high clinical interest.
The aim. To identify the risk factors of arterial thrombosis in patients with chronic peripheral arterial occlusive diseases.
Materials and methods. 47 patients with CPAOD were studied. They were distributed into 2 clinical groups: group 1 consisted of 29 patients without any history of reconstructive surgical treatment and group 2 - 18 patients with the thrombosis of arteries / bypass grafts of the lower extremities after reconstructive surgery. The parameters of coagulation, homocysteine level, allelic variants of genes associated with plasma hemostasis were studied.
Results. Important markers of hypercoagulation such as significant increase of fibrinogen concentration, factor VIII activity, activity and level of von Willebrand factor were found in both groups, regardless of thrombotic history. The distinctive feature of patients of group 2 was more prominent increase of activity and level of von Willebrand factor in comparison with patients of group 1 (p<0.05). Also, in group 2 a significant decrease of antithrombin activity was determined in comparison with control group and patients without thrombotic manifestations (p <0.05). Mutation in the factor V gene (G1691A, Leiden mutation) was more common in patients who underwent surgical treatment (19.3% vs. 9.3% in patients without surgical treatment). The factor II mutation (G20210A) was likewise more common in group 2 than in the group 1 (6.1% and 3.6%, respectively). An increase of homocysteine level, regardless of the allele of methylenetetrahydrofolate reductase gene (MTHFR), was diagnosed in 34.3% of patients in group 2 and 9.6% in group 1.
Conclusion. The risk factors determining procoagulant changes of hemostasis in patients with CPAOD were revealed. The main factors increasing the procoagulant directivity of hemostasis disorders in patients of the second group were the following: endothelial dysfunction, a decrease of antithrombin activity, as well as a high incidence of hyperhomocysteinemia and mutations in the factor V (G1691A) and factor II (G20210A) genes associated with a predisposition to thrombosis. All patients with CPAOD were characterized by the procoagulant tendency of plasma hemostasis, mostly pronounced in patients with the thrombosis of arteries / bypass grafts of the lower extremities after reconstructive surgery. Based on above mentioned factors we state the necessity of clinical and laboratory assessment of the predisposition to thrombosis in patients with CPAOD in order to determine the risks of surgical treatment and individualize the therapy.
1. Nacionalnie rekomendacii po diagnostike i lecheniu zabolevanii arterii nijnih konechnostei. - M., - 2019. - S. 9-17.
2. Babichev A.V. Rol endoteliya v mehanizmah gemostaza. Pediatr. - 2013. - T.4, 1. - S. 122-128.
3. Dombrovskii A.L., Sergienko I.V., Rvacheva A.V., et al. Vliyanie terapii atorvastatinom v razlichnih dozah na endotelialnie progenitornie kletki i faktori angiogeneza y bolnih ishemicheskoi boleznu serdca. Ateroskleroz i dislipidemii. 2015. - T.2. - C.56-68.
4. Olinic DM, Spinu M, Olinic M, Homorodean C, Tataru DA, Liew A, et al. Epidemiology of peripheral artery disease in Europe: VAS Educational Paper. Int Angiol. - 2018. - Vol. 37. - P. 327-334.
5. 2018 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. - 2018. - P. 1-64.
6. Lusis A.J., Mar R., Pajukanta P. Genetics of atherosclerosis. Annu Rev Genomics Hum Genet. - 2004. -5. - P. 189-218.
7. Ross R., Glomset J.A. The pathogenesis of atherosclerosis (first of two parts). N Engl J Med 1976. -Vol.295. - P. 420-425.
8. Norgren L. et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) // J. Vasc. Surg. Elsevier BV. - 2007. - Vol.45, 1. - P. 5-67.
9. Howard DP, Banerjee A, Fairhead JF, Hands L, Silver LE, Rothwell PM. Population-based study of incidence, risk factors, outcome, and prognosis of ischemic peripheral arterial events: implications for prevention. Circulation. - 2015. -Vol. 132. - P. 5-15.
10. Rossiiskie klinicheskie rekomendacii po diagnostike, lecheniu i profilaktike venoznih tromboembolicheskih oslojnenii (VTEO). Flebologiya. - T.9, 4. - 2015. - S. 5-7.