Prognostic value of D-dimer and markers of coagulation for stratification of abdominal aortic aneurysm growth

Abstract

Abdominal aortic aneurysm (AAA) is associated with high morbidity and mortality and is an established cause of unbalanced hemostasis. A number of hemostatic biomarkers have been associated with AAA; however, the utility of hemostatic biomarkers in AAA diagnosis and prognosis is unclear. The aim of the present study was to characterize the potential prognostic value of D-dimer and markers of altered hemostasis in a large cohort of patients with AAAs characterized by either fast or slow aneurysm growth (frequency matched for baseline diameter) and subaneurysmal dilations. We measured plasma concentrations of thrombin-antithrombin (TAT) complex, platelet factor 4 (PF4), and D-dimer in 352 patients with either fast-growing AAAs (>2 mm/y), slow-growing AAAs (<2 mm/y), subaneurysmal aortic dilations, or nonaneurysmal aortas. Plasma D-dimer and TAT were significantly elevated in both AAA and subaneurysmal dilation patients compared with controls. Individuals with D-dimer levels ≥500 ng/mL had 3.09 times the odds of subaneurysms, 6.23 times the odds of slow-growing AAAs, and 7.19 times the odds of fast-growing AAAs than individuals with D-dimer level <500 ng/mL. However, no differences in D-dimer concentration were noted between fast- and slow-growing aneurysms. Plasma D-dimer and TAT were strong independent predictors of AAA growth rate with multivariate analysis revealing a 500-ng/mL increase in D-dimer or 1-µg/mL increase in TAT led to additional 0.21-mm and 0.24-mm changes in aortic diameter per year, respectively. Rising levels of plasma TAT, in addition to D-dimer, may predict disease progression and aneurysm growth in patients with AAA or subaneurysmal dilation.

Plasma Metabolomics Analysis Identifies Abnormal Energy, Lipid, and Amino Acid Metabolism in Abdominal Aortic Aneurysms

“…AAAs are characterized by progressive luminal dilation accompanied by aortic wall inflammation, decreased medial smooth muscle cells, and disruption of the extracellular matrix. Although studies have been conducted on a variety of biologically plausible markers for diagnosis and prediction of disease activity in AAA [ 5 – 7 ], there is still a need for a systematic understanding of biological disturbances associated with the condition. Metabolomics is a high-throughput omics technology that follows on the heels of genomics, transcriptomics, and proteomics, and which can be used to simultaneously measure and study a large number of small molecules (<1000 Da) [ 8 ].…”

Circulating Biomarkers for the Prediction of Abdominal Aortic Aneurysm Growth

“…Eight studies presenting data on clinical biomarkers were included; one randomized control trial [ 18 ], 3 prospective [ 19 , 20 , 21 ], and 4 retrospective [ 22 , 23 , 24 , 25 ] observational studies, published between 2008 and 2018 ( Table 1 ). All analyses assessed patients that underwent screening controls or were hospital referrals and presented an AAA of more than 30 mm of diameter (range 30–50 mm).…”

“…Among studies presenting clinical biomarkers, the most commonly applied one was D-dimers which was assessed in three studies [ 20 , 21 , 25 ]. D-dimers’ role as an indicator of the process of thrombosis and thrombolysis and their known association with other cardiovascular entities has been assessed to further identify their potential impact on AAA evolution.…”

“…For the evaluation of aneurysm growth, duplex ultrasonography (DUS) was used in the vast majority of the studies (23 out of 25 studies) [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 ]. Aneurysm growth definition varied among studies.…”

Perioperative cardiovascular complications rate and activity of coagulation and fibrinolysis among patients undergoing vascular surgery for peripheral artery disease and abdominal aortic aneurysm

“…diameter of aneurysm in AAA and intensity of symptoms in PAD). 8 , 9 Some previous studies pointed to a significant role of procoagulant activity of intraluminal thrombus in patients with AAA 10 while in case of PAD, the most crucial pathomechanism is related to atherosclerotic endothelial damage which leads to the formation of thrombi and subsequent activation of hemostasis. To the best of our knowledge there are no available reports directly comparing these two groups of patients in terms of baseline preoperative coagulation and fibrinolysis activity.…”