Effects of warfarin therapy on plasma fibrinogen, von Willebrand factor, and fibrin D-dimer in left ventricular dysfunction secondary to coronary artery disease with and without aneurysms

Lip, Gregory Y.H.; Lowe, G. D. O.; Metcalfe, M. J.; Rumley, Ann; Dunn, Francis G.

doi:10.1016/s0002-9149(99)80129-5

Cited by 58 publications

(29 citation statements)

References 14 publications

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“…21 Indeed, elevated vWF levels are associated with an increased risk of reinfarction and mortality in post-MI patients. 22 Elevated vWF levels have previously been observed in patients with left ventricular aneurysms, 23 but there was no relationship between vWF and LVEF, as in the present study. Although there was a trend toward higher vWF levels in patients with more severe symptoms (NYHA class III-IV), these differences were not statistically significant.…”

Section: Gibbs Et Al Hemorheological Endothelial and Platelet Functionsupporting

confidence: 49%

Abnormalities of Hemorheological, Endothelial, and Platelet Function in Patients With Chronic Heart Failure in Sinus Rhythm

et al. 2001

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Background —To investigate the hypothesis that abnormalities of hemorheological (fibrinogen, plasma viscosity), endothelial (von Willebrand factor [vWF]), and platelet (soluble P-selectin) function would exist in patients with chronic heart failure (CHF) who are in sinus rhythm, we conducted a cross-sectional study of 120 patients with stable CHF (median ejection fraction 30%). We also hypothesized that ACE inhibitors and β-blockers would beneficially affect the measured indices. Methods and Results —In the cross-sectional analysis, plasma viscosity ( P =0.001), fibrinogen ( P =0.02), vWF ( P <0.0001), and soluble P-selectin ( P <0.001) levels were elevated in patients with CHF compared with healthy controls. Women demonstrated greater abnormalities of hemorheological indices and vWF than males (all P <0.05). Plasma viscosity ( P =0.009) and fibrinogen ( P =0.0014) levels were higher in patients with more severe symptoms (New York Heart Association [NYHA] class III–IV), but there was no relationship with left ventricular ejection fraction. When ACE inhibitors were introduced, there was a reduction in fibrinogen (repeated-measures ANOVA, P =0.016) and vWF ( P =0.006) levels compared with baseline. There were no significant changes in hemorheological, endothelial, or platelet markers after the introduction of β-blocker therapy, apart from a rise in mean platelet count ( P <0.001). Conclusions —Abnormal levels of soluble P-selectin, vWF, and hemorheological indices may contribute to a hypercoagulable state in CHF, especially in female patients and in those with more severe NYHA class. Treatment with ACE inhibitors improved the prothrombotic state in CHF, whereas the addition of β-blockers did not. These positive effects of ACE inhibitors may offer an explanation for the observed reduction in ischemic events in clinical trials.

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Section: Gibbs Et Al Hemorheological Endothelial and Platelet Functionsupporting

confidence: 49%

Abnormalities of Hemorheological, Endothelial, and Platelet Function in Patients With Chronic Heart Failure in Sinus Rhythm

et al. 2001

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“…The reduction in D-dimer (by 24%) is also notable and only moderately lower than reported for the established antithrombotic drug warfarin, for which the reported reduction in plasma D-dimer ranges from 32% to 58%. 28,29 The changes observed contribute to a rational understanding of the functional improvements associated with ramipril in patients with intermittent claudication.…”

Section: Discussionmentioning

confidence: 98%

Potential Vascular Mechanisms of Ramipril Induced Increases in Walking Ability in Patients With Intermittent Claudication

Ahimastos

Latouche

Natoli

et al. 2014

Circulation Research

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Rationale: We recently reported that ramipril more than doubled maximum walking times in patients with peripheral artery disease with intermittent claudication. Objective: Our aim was to conduct exploratory analyses of the effects of ramipril therapy on circulating biomarkers of angiogenesis/arteriogenesis, thrombosis, inflammation, and leukocyte adhesion in patients with intermittent claudication. Methods and Results: One hundred sixty-five patients with intermittent claudication (mean, 65.3 [SD, 6.7] years) were administered ramipril 10 mg per day (n=82) or matching placebo (n=83) for 24 weeks in a randomized, double-blind study. Plasma biomarkers of angiogenesis/arteriogenesis (vascular endothelial growth factor-A, fibroblast growth factor-2), thrombosis (D-dimer, von Willebrand factor, thrombin-antithrombin III), inflammation (high-sensitivity C-reactive protein, osteopontin), and leukocyte adhesion (soluble vascular cell adhesion molecule-1, soluble intracellular adhesion molecule-1) were measured at baseline and 24 weeks. Relative to placebo, ramipril was associated with increases in vascular endothelial growth factor-A by 38% (95% confidence interval [CI], 34%–42%) and fibroblast growth factor-2 by 64% (95% CI, 44–85%; P <0.001 for both), and reductions in D-dimer by 24% (95% CI, −30% to −18%), von Willebrand factor by 22% (95% CI, −35% to −9%), thrombin-antithrombin III by 16% (95% CI, −19% to −13%), high-sensitivity C-reactive protein by 13% (95% CI, −14% to −9%), osteopontin by 12% (95% CI, −14% to −10%), soluble vascular cell adhesion molecule-1 by 14% (95% CI, −18% to −10%), and soluble intracellular adhesion molecule-1 by 15% (95% CI, −17% to −13%; all P <0.001). With the exception of von Willebrand factor, all the above changes correlated significantly with the change in maximum walking time ( P =0.02−0.001) in the group treated with ramipril. Conclusions: Ramipril is associated with an increase in the biomarkers of angiogenesis/arteriogenesis and reduction in the markers of thrombosis, inflammation, and leukocyte adhesion. This study informs strategies to improve mobility in patients with intermittent claudication. Clinical Trial Registration Information: URL: http://clinicaltrials.gov . Unique identifier: NCT00681226.

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“…An elevated D-Dimer unrelated to thrombus formation may be seen in patients with sepsis or malignancy, in association with markedly elevated C-reactive protein levels, following surgery, in elderly patients per se and those who have undergone prolonged hospitalisation [19][20][21][22]; in such patients reliance upon clinical evaluation and diagnostic imaging studies is more valuable. Conversely, the requesting clinician must be alert to occasions when the D-Dimer value may be falsely suppressed, including those receiving heparin treatment [23] or warfarin therapy [24][25][26], and measurement in patients receiving such anticoagulation should be viewed with caution.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism: investigation of the clinically assessed intermediate risk subgroup

Warren¹,

Matthews²

2012

BJR

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Objectives: The simplified Wells pre-test probability scoring algorithm for preinvestigation evaluation of pulmonary emboli (PE) is a commonly utilised and validated assessment tool. We sought to identify whether use of a dichotomised scoring system altered the overall negative predictive value (NPV) in patients referred for CT pulmonary angiography (CTPA) assessment of suspected PE. Methods: Prospective data collection of all patients referred for CTPA evaluation of suspected acute PE during a 3 year period was carried out. Pre-test risk stratification was performed according to simplified Wells criteria in conjunction with plasma D-Dimer (BioPool and IL test) estimation. Retrospective dichotomisation was also performed. Results: 2531 patients were investigated for suspected acute PE; acute thromboemboli were confirmed in 22.7%. The overall NPV for negative D-Dimer and intermediate pre-test probability (PTP) was 98.9% [95% confidence interval (CI) 96.3-99.7%]; with retrospective dichotomisation, the NPV for the PE unlikely group was 99.0% (95% CI 94.8-99.8%). Implementation of dichotomised scoring, excluding PE unlikely with negative D-Dimer cases from further imaging, would have yielded a 4% reduction in CTPA referral pathway imaging at our institution. Conclusion: We demonstrate no significant difference between exclusion in the intermediate subgroup and the retrospectively dichotomised PE unlikely group and demonstrate the high negative predictive power of the Bio-Pool and IL tests in conjunction with the Wells PTP tool. Prior to implementation of new guidelines for exclusion of patients with suspected PE from further imaging, hospitals should audit their own practice and validate the D-Dimer assay utilised at their institution.

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Effects of warfarin therapy on plasma fibrinogen, von Willebrand factor, and fibrin D-dimer in left ventricular dysfunction secondary to coronary artery disease with and without aneurysms

Cited by 58 publications

References 14 publications

Abnormalities of Hemorheological, Endothelial, and Platelet Function in Patients With Chronic Heart Failure in Sinus Rhythm

Abnormalities of Hemorheological, Endothelial, and Platelet Function in Patients With Chronic Heart Failure in Sinus Rhythm

Potential Vascular Mechanisms of Ramipril Induced Increases in Walking Ability in Patients With Intermittent Claudication

Pulmonary embolism: investigation of the clinically assessed intermediate risk subgroup

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