Haemostatic markers in patients with abdominal aortic aneurysm and the impact of aneurysm size

Abstract 

Introduction

Abdominal aortic aneurysm is a common condition with high mortality when rupturing. However, the condition is also associated with nonaneurysmal cardiovascular mortality. A possible contributing mechanism for the thrombosis related cardiovascular mortality is an imbalance between the activation of the coagulation system and the fibrinolytic system. The aim of the present study was to investigate haemostatic markers in patients with nonruptured abdominal aortic aneurysm with special regard to the influence of aneurysm size and smoking habits.

Methods

Seventy-eight patients with infrarenal aortic aneurysm and forty-one controls without aneurysm matched by age, gender and smoking habits were studied. Thrombin-antithrombin (TAT), prothrombin fragment 1+2 (F 1+2) - markers of thrombin generation, and von Willebrand factor antigen (vWFag) - considered as a reliable marker of endothelial dysfunction - were measured. Plasma levels of tissue plasminogen activator antigen (tPAag), and plasminogen activator inhibitor type 1 (PAI-1) were measured as markers of fibrinolytic activity. D-dimer, a marker of fibrin turnover, was also measured.

Results

There were significantly higher levels of TAT and D-dimer in patients with abdominal aortic aneurysm. The highest level of TAT and D-dimer were detected in patients with large compared to small AAA.

Conclusions

The present data indicate a state of activated coagulation in patients with abdominal aortic aneurysm which is dependent by aneurysm size. The activated coagulation in AAA patients could contribute to an increased cardiovascular risk in patients also with small AAA. The possible impact of secondary prevention apart from smoking cessation has to be further evaluated and is maybe as important as finding patients at risk of rupture.

Abbreviations: AAA, abdominal aortic aneurysm, ELISA, enzyme-linked immunosorbent assay, TAT, thrombin-antithrombin, F 1+2, prothrombin fragment 1+2, vWFag, von Willebrand factor antigen, tPAag, tissue plasminogen activator antigen, PAI-1, plasminogen activator inhibitor type 1, aPTT, activated partial thromboplastin time, PT, prothrombin time, INR, International Normalized Ratio, CV, coefficient of variation

Keywords: Coagulation, Fibrinolysis, Aortic aneurysm, Abdominal