Markers of hypercoagulability and inflammation predict mortality in patients with heart failure

Abstract

inflammation predict mortality in patients with heart failure. J Thromb Haemost 2006; 4: 1017-22.Summary. Background and aims: Plasma levels of inflammatory markers are increased in chronic heart failure (HF) and are also subclinical indicators of future HF. Inflammation is strictly correlated with clotting activation, but the association between inflammation, hypercoagulability and prognosis in HF has not been previously reported. Methods and results: Markers of inflammation (interleukin-6; IL-6, and C-reactive protein; CRP) and hypercoagulability (D-dimer; DD, and thrombinantithrombin III complex; TAT) were prospectively assessed in 214 subjects with New York Heart Association (NYHA) functional class II-IV HF. During a median follow-up of 8.5 months, 32 patients had an event: 13 died and 19 were hospitalized because of worsening of HF. IL-6, DD and TAT levels were all significantly associated with increased risk of death after adjustment for other known HF prognostic factors (age, gender, traditional cardiovascular risk factors, NYHA class, systolic left ventricular function, renal failure, hemoglobin, serum sodium) in a Cox multivariate proportional hazard model (P ¼ 0.003, P ¼ 0.01 and P ¼ 0.02, respectively). When these markers were added simultaneously to the known prognostic factors in a new Cox multivariate model, only DD levels were significant predictors of mortality (hazard ratio [95% confidence interval; CI]: 11 [2.7-45.1], P ¼ 0.001). The Kaplan-Meier curve revealed a significantly better outcome in patients with DD below 450 ng mL )1. NT-pro-BNP was the only significant predictor of rehospitalization (HR [95% CI]: 5.3 [2.0-13.8], P < 0.001). Conclusion: Hypercoagulability and inflammation, as assessed by DD, TAT and IL-6 levels, are associated with an increased mortality risk in HF.

Response of the coagulation system after application of hemostatic dressings in an animal model

“…Elevated TAT concentrations and suppressed AT III activity are signs of thrombogenesis. Very high levels of TAT could imply that the described processes were accelerated by the administration of procoagulants (Marcucci et al 2006). Thrombocytopenia was observed in the first hour after the application of the hemostatic agent.…”

Association of D-dimer levels with all-cause mortality in a healthy adult population: findings from the MOLI-SANI study

“…10 Besides the cardiovascular setting, elevated D-dimer levels have been associated with higher risk of total mortality in apparently healthy subjects 19 and in patients with different diseases. 20,21 Systemic activation of hemostasis is frequently observed in cancer patients, even in the absence of thrombosis. 22,23 Moreover, this activation has been implicated in cancer progression, angiogenesis and metastatic spread.…”

Upper extremity deep venous thrombosis and stenosis after implantation of pacemakers and defibrillators; A prospective study

“…Narrowing of the vessel and endothelial damage due to manipulations with more leads and especially with a guiding catheter during CRT implantation may make the vein susceptible for thrombosis or subsequent scar formation after implanting a CRT. Heart failure and low cardiac output, which reduce the blood flow in the central veins and the increased coagulability state, may also have an additive effect on this susceptibility [15,17,18].…”