LABORATORY EVIDENCE OF HYPERFIBRINOLYSIS IN ASSOCIATION WITH LOW PAI-1 ACTIVITY
Abstract number: P-S-349
Ågren1 A., Wiman2 B., Schulman3 S.
11Department of Hematology, Coagulation Unit 22Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden 33Department of Medicine, McMaster University, Hamilton, ON, Canada
How-to-cite Ågren A, Wiman B, Schulman S. LABORATORY EVIDENCE OF HYPERFIBRINOLYSIS IN ASSOCIATION WITH LOW PAI-1 ACTIVITY. J Thromb Haemost 2007; 5 Supplement 2: P-S-349
Introduction: Low activity of plasminogen activator inhibitor type 1 (PAI-1) has been associated with bleeding complications in surgery. We have earlier reported a higher prevalence of low PAI-1 activity among patients with bleeding tendency as compared to normal controls. The purpose of this study was to evaluate if low PAI-1 activity actually is associated with markers of increased fibrinolytic activity in plasma in a well characterized patient material.
Methods: PAI-1 activity, PAP and D-dimer were analyzed in plasma samples from 424 consecutive patients referred to the Coagulation Unit due to bleeding symptoms.
Results: The median PAI-1 activity was 4.0 U/mL (interquartile range [IQR] 1-10 U/mL), the median PAP level was 1.59 mg/L (IQR 1.40-1.91) and the median D-dimer level was 71 mg/L (IQR 46-111). The median PAP-concentration for patients with PAI-1 <1.0 U/mL was 1.73 mg/L (IQR 1.53-2.30) and for PAI-1 >1.0 U/mL it was 1.54 mg/L (IQR 1.36-1.83) (p<0.0001). There was also a significant difference between the PAP-levels between patients with normal PAI-1 (1-15 U/ml) and elevated PAI-1 (>15 U/mL) (p=0.024). The level of D-dimer did not correlate with PAI-1 activity.
Conclusions: The activation of plasminogen measured as PAP, is higher in patients with bleeding symptoms in combination with PAI-1 activity <1.0 U/mL than in those with PAI-1 activity >=1.0 U/mL. The coagulation activity, as measured by D-dimer, is not higher in patients with bleeding symptoms and low PAI-1 activity under normal conditions. The results support our previous definition of low PAI-1 as activity <1.0 U/mL.
References: 1 Schleef RR, Higgins DL, Pillemer E, Levitt LJ. Bleeding diathesis due to decreased functional activity of type 1 plasminogen activator inhibitor. J Clin Invest 1989; 83: 1747-1752.
2 Ågren A, Wiman B, Stiller V, Lindmarker P, Sten-Linder M, Carlsson A, et al. Evaluation of low PAI-I activity as a risk factor for hemorrhagic diathesis. J Thromb Haemost 2006; 4: 201-208.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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