fibrinopeptide-a and Arterial-Occlusive-Diseases

To minimize intraoperative blood loss a watertight knitted Dacron aortoiliac prosthesis has been developed by impregnation with bovine collagen. A potential disadvantage is that collagen may be associated with an increase in thrombus formation. We conducted a prospective randomized trial to study the systemic effects of collagen-impregnated prostheses and of aortoiliac operation as such on the coagulation mechanism during the first 10 days after operation. Forty-one patients randomly received either a collagen-impregnated (n = 20) or a nonimpregnated prosthesis (n = 21). Twelve patients who underwent cholecystectomies served as controls. Three markers of the coagulation mechanism were monitored: beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation products. We found no significant differences in median beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation product levels between patients in the collagen-impregnated prosthesis group and patients in the nonimpregnated prosthesis group. This indicates that collagen does not stimulate the coagulation cascade any more than conventional Dacron protheses do. In a comparison of patients who underwent aortoiliac reconstruction and patients who underwent cholecystectomies, the results indicated a significant increased platelet activation and fibrin metabolism in aortoiliac reconstruction group compared with the control group. Finally, we observed a significantly higher preoperative fibrin metabolism in patients with vascular disease than in control subjects. This difference is attributable to the high preoperative fibrin/fibrinogen degradation product values in patients with aortic aneurysms.

Topics: Adult; Aged; Aged, 80 and over; Aorta; Aortic Aneurysm; Arterial Occlusive Diseases; beta-Thromboglobulin; Blood Vessel Prosthesis; Collagen; Female; Femoral Artery; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Graft Occlusion, Vascular; Humans; Iliac Artery; Male; Middle Aged; Platelet Activation; Polyethylene Terephthalates

There is evidence that the coagulation system is activated in patients with peripheral arterial occlusive disease (PAOD). The beneficial effects of the vasoactive drug prostaglandin E1 (PGE1) may rely in part on the modulation of the coagulation system. The study was designed to evaluate the effects of PGE1 on hemostatic and fibrinolytic variables in patients with intermittent claudication. Therefore molecular markers of thrombin (prothrombin fragment 1+2, PTF 1+2; thrombin-antithrombin III complexes, TAT) and fibrin formation (fibrinopeptide A, FPA) and markers of the fibrinolytic activity (fibrin degradation products, D-dimers) were determined before and immediately after the first PGE1 dose (60 microg in 100 ml NaCl over 2 h i.v.) as well as after 4 weeks of daily infusion therapy in 12 PAOD patients and in eight control patients before and after a single placebo infusion. Plasma levels of PTF1+2, TAT, FPA and D-dimers tended to decrease after the initial dose of PGE1. Infusion therapy with PGE1 for 4 weeks led to a decrease of all hemostatic and fibrinolytic parameters with most pronounced changes for PFT1+2, D-dimers and plasminogen activator inhibitor-1 decreasing by 11% (P<0.05), 20% (P<0.05), and 7% (P<0.05), respectively. These variables remained unchanged in controls with placebo infusion. In summary, infusion therapy with PGE1 in patients with PAOD reduces thrombin formation and results in a decrease of fibrin degradation. PGE1 may thus reduce fibrin deposition involved in the pathogenesis of atherosclerosis.

Topics: Aged; Alprostadil; Antithrombin III; Arterial Occlusive Diseases; Case-Control Studies; Dimerization; Fibrin; Fibrinolysis; Fibrinopeptide A; Hemostasis; Humans; Intermittent Claudication; Male; Middle Aged; Peptide Hydrolases; Placebos; Plasminogen Activator Inhibitor 1; Prothrombin; Thrombin; Time Factors

We determined the specific marker of thrombin activity, fibrinopeptide A (FPA), in the vicinity of dilated sites during percutaneous transluminal angioplasty (PTA) for femoro-popliteal obstructions in 24 patients. Blood samples were drawn proximal to dilated segments from a 4F catheter inserted retrogradely in the common femoral artery and distal to dilated segments from the balloon catheter tip. Median +/- S.E. FPA concentration was 21.5 +/- 4.4ng ml-1 before PTA. Immediately after dilatation, FPA concentrations were increased to 970.0 +/- 836.9 ng ml-1 distal to dilated segments (p less than 0.00005) and to 48.5 +/- 11.4 ng ml-1 proximally (p less than 0.003). Segmentally enclosed thrombolysis (SET) was undertaken immediately after PTA, when a double balloon catheter was positioned with a balloon at each end of dilated segments. Both balloons were inflated and 5 mg recombinant tissue plasminogen activator (rt-PA) and 1000 IU heparin were enclosed in the segments for 30 min. Immediately after SET, FPA concentration distal to dilated segments was 34.0 +/- 14.2 ng ml-1 and not different from proximal concentrations found after PTA (p = 0.57). Intense fibrinolysis was indicated by significantly increased levels of cross-linked fibrin degradation products (D-dimer) for hours after SET, but FPA concentrations in peripheral blood remained near baseline values. This finding differed from increased thrombin activity found by others during systemic thrombolytic therapy. Early rethrombosis did not occur after PTA in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Arterial Occlusive Diseases; Female; Femoral Artery; Fibrinopeptide A; Humans; Male; Middle Aged; Popliteal Artery; Thrombin; Thrombolytic Therapy

Levels of the platelet degranulation product beta-thromboglobulin (BTG) and the fibrinogen degradation product fibrinopeptide A (FPA) were measured in 26 asymptomatic subjects (group 1), 17 patients with peripheral vascular disease (PVD) (group 2), and 12 patients with PVD and bypass grafts (group 3). Mean BTG and FPA levels were elevated in both groups 2 and 3, indicating increased thrombotic activity in patients with PVD. Results of serial BTG and FPA assays in group 3 patients suggested a trend downward. These markers may be useful for estimating disease severity and prognosis, extent of graft healing and patency, and efficacy of therapeutic intervention.

Topics: Arterial Occlusive Diseases; beta-Thromboglobulin; Blood Vessel Prosthesis; Female; Fibrinogen; Fibrinopeptide A; Humans; Male; Prognosis; Radioimmunoassay; Thrombosis; Time Factors; Wound Healing