Coagulation Profiles of Pulmonary Arterial Hypertension Patients, Assessed by Non-Conventional Hemostatic Tests and Markers of Platelet Activation and Endothelial Dysfunction
Eleni Vrigkou,
Argyrios E. Tsantes,
Petros Kopterides,
Stylianos E. Orfanos,
Apostolos Armaganidis,
Eirini Maratou,
Evdoxia Rapti,
Athanasios Pappas,
Andreas G. Tsantes,
Iraklis Tsangaris
Affiliations
Eleni Vrigkou
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Argyrios E. Tsantes
Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Petros Kopterides
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Stylianos E. Orfanos
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Apostolos Armaganidis
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Eirini Maratou
Laboratory of Clinical Biochemistry, “Attikon” University Hospital, Medical School, University of Athens, Rimini 1, 12462 Athens, Greece
Evdoxia Rapti
Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Athanasios Pappas
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Andreas G. Tsantes
Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Iraklis Tsangaris
Second Department of Critical Care Medicine, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece
Many pathophysiologic processes of pulmonary arterial hypertension (PAH), namely, excess vasoconstriction, vascular remodeling and in situ thrombosis, involve the coagulation cascade, and more specifically, platelets. The aim of this study was to globally assess coagulation processes in PAH, by using non-conventional hemostatic tests, along with markers of platelet activation and endothelial dysfunction. We studied 44 new PAH patients (22 with idiopathic PAH and 22 with connective tissue disease) and 25 healthy controls. The following tests were performed: platelet function analyzer-100 (PFA-100), light transmission aggregometry (LTA), rotational thromboelastometry (ROTEM), endogenous thrombin potential (ETP), serotonin, thromboxane A2 and p-selectin plasma levels, and von Willebrand antigen (VWF:Ag) and activity (VWF:Ac). Our results showed that PAH patients had diminished platelet aggregation, presence of disaggregation, defective initiation of the clotting process and clot propagation, and diminished thrombin formation capacity. Serotonin, thromboxane A2 and p-selectin levels were increased, and VWF:Ag and VWF:Ac decreased in the same population. The results of this study suggest that the platelets of PAH patients are activated and present functional abnormalities. The procoagulant activity, in general, appears to be impaired probably due to a sustained and prolonged activation of the procoagulant processes. Larger observational studies are warranted to confirm these laboratory findings.
