Editorial Slides VP Watch, March 05, 2003, Volume 3, Issue 9

Vulnerable (Thrombogenic) Blood; A New Step Towards The Definition Of Vulnerable Patients

Morteza Naghavi, MD

–Pathology studies have consistently shown that plaque rupture are often not accompanied by luminal occlusive thrombi.

–Silent plaque rupture is a well supported observation.

– The questions are in what circumstances plaque ruptures go silent and remain undetected. What are the other additional factors that play a role in the clinical outcome of atherosclerosis besides plaque rupture?

– Though the reasons for this are unknown, it seems clear that blood thrombogenicity plays a significant role in the outcome of plaque rupture or erosion.

– One putative link between the plaque complication and the ensuing thrombosis is the circulating tissue factor (TF)1,2 that has been shown to be present in platelets in the setting of thrombi.3

– Therefore, it is not surprising that TF is increased in plasma of patients with acute coronary syndromes, compared to patients with stable angina.4

–As featured in VPWatch of this week, Sambola, Badimon and colleagues5 studied the tissue factor levels and blood thrombogenicity in the Badimon perfusion chamber of poorly-controlled patients with Type 2 diabetes, smokers and untreated hyperlipidemic patients.

Control

Circulating Tissue Factor Activity is Statistically Increased in Circulating Tissue Factor Activity is Statistically Increased in Smokers and Patients with HyperlipidemiaSmokers and Patients with Hyperlipidemia

In patients with diabetes, the TF activity decreased withimprovement of glycemia status. Blood thrombogenicity decreased

in agreement with lower TF.

• This study correlates increased levels of circulating tissue factor activity associated with diabetes mellitus, hyperlipidemia, and smoking.

Conclusion:

• These data indicate that the previously reported hyperthrombotic state responsible for the increased rate of atherothrombotic complications among diabetic, hyperlipemic, and smoker populations could be mediated via increased levels of circulating TF.

Conclusion:

• The authors concluded: - 1) Increased blood thrombogenecity in poorly

controlled T2DM seems to be related to plasma levels of a circulating pool of activatable TF activity.

- 2) Improvements in glycemic control are associated with a reduction in plasma levels of circulating TF activity and BT.

- 3) Risk factors such as hyperlipidemia and smoking have a significant modulatory effect on plasma levels of circulating TF and BT.

Conclusion:

• Increased thrombogenesity of circulating blood is the most important factor for development of coronary thrombosis?

– Agree– Disagree– Data not available

Questions:

• Decreased endogenous fibrinolytic activity of blood is the most important factor in coronary thrombosis

– Agree– Disagree– Data not available

Questions:

• Thrombogenic lipid core in a vulnerable plaque is the most important factor in coronary thrombosis.

– Agree– Disagree– Data not available

Questions:

• Silent plaque rupture is mainly due to having non-thrombogenic blood.

– Agree– Disagree– Data not available

Questions:

• Silent plaque rupture is mainly due to having an active fibrinolytic system.

– Agree– Disagree– Data not available

Questions:

• Silent plaque rupture is mainly due to having a non-thrombogenic lipid core.

– Agree– Disagree– Data not available

Questions: