Raised Fibrinogen Levels and Outcome in Outpatients With Peripheral Artery Disease

Altes, Pere; Pérez, Paulina; Esteban, Carlos; Muñoz-Torrero, Juan Francisco Sánchez; Aguilar, Eduardo; Garcı́a-Dı́az, Ana; Álvarez, Lorenzo Ramón; Jiménez, P.; Sahuquillo, Joan Carles; Monréal, Manuel; Investigators, Frena

doi:10.1177/0003319717739720

Cited by 22 publications

(13 citation statements)

References 27 publications

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“…On the one hand, inflammatory factors such as CRP can directly inhibit EPC survival, differentiation, and angiogenic potency [28]. Fibrinogen also plays a leading role in thrombosis, and elevated fibrinogen can increase the cumulative rates of ischemic events in the course of PAD [29, 30]. Our results revealed that both fibrinogen > 4 g/L and CRP > 3 mg/L can be predictors that are independent of the other factors.…”

Section: Discussionmentioning

confidence: 87%

Predictors of responders to mononuclear stem cell-based therapeutic angiogenesis for no-option critical limb ischemia

et al. 2019

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BackgroundAlthough the mononuclear cell (MNC) transplantation could theoretically induce therapeutic angiogenesis in the patients with no-option critical limb ischemia (NO-CLI), the clinical responses to this approach are inconsistent among different clinical trials. The purpose of this study was to identify the prognostic factors of responders and develop a predictive nomogram to guide patient selection.MethodsWe retrospectively reviewed a consecutive NO-CLI cohort who received peripheral blood-derived transplantation in our center. The patients who survived and achieved complete remission of CLI at 6 months post-transplantation were defined as responders. Logistic regression models were used to screen and identify the prognostic factors based on which predictive nomogram was developed. A receiver operating characteristic (ROC) curve and a calibration curve were drawn to determine the discrimination level and predictive accuracy.ResultsThe study ultimately enrolled 103 patients, including 58 responders and 45 non-responders. Based on the multivariate regression analysis, age ≥ 50 years (odds ratio [OR] 0.201, P = 0.004), blood fibrinogen > 4 g/L (OR 0.176, P = 0.003), arterial occlusion above the knee/elbow (OR 0.232, P = 0.010), the transcutaneous pressure of oxygen (TcPO2) (OR 1.062, P = 0.006), and the Log total transplanted CD34+ cell count (OR 3.506, P = 0.046) were identified as independent prognostic factors of the responders in the nomogram. An area under the ROC curve of 0.851 indicated good discrimination, and the calibration curve of the predicted probability showed optimal agreement with that of the observed probability.ConclusionsAge, blood fibrinogen, arterial occlusion level, TcPO2, and the total transplanted CD34+ cell count were independent prognostic factors of the responders. A nomogram with high discrimination and accuracy was developed to provide individualized predictions.Trail registrationChiCTR, ChiCTR1800019401. Registered 9 November 2018—Retrospectively registeredElectronic supplementary materialThe online version of this article (10.1186/s13287-018-1117-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 87%

Predictors of responders to mononuclear stem cell-based therapeutic angiogenesis for no-option critical limb ischemia

et al. 2019

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“…Altes et al explored the outcome of patients with stable PAD and raised fibrinogen levels in the outpatient setting. [2] Their findings showed that during 18 months of follow up these patients with raised fibrinogen had a two-fold increase in the rate of ischemic stroke, limb amputation and death. Establishing fibrinogen as an independent risk factor for prognosis of patients with PAD has been a topic of interest.…”

Section: Discussionmentioning

confidence: 97%

Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

Bosevski

Krstevski

Mitevska

et al. 2018

Prilozi

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These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

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“…Fibrinogen has a wellknown impact on clot strength [22]. Fibrin-clot property can affect the risk of PAD, including the premature disease, and CV outcomes [14,[23][24][25]. In addition, fibrinolytic activity affects cardiovascular outcomes in high-risk patients, as best shown for the PLATO (PLATelet inhibition and patient Outcomes) trial [26].…”

Section: Hypercoagulability/fibrinolysis and Padmentioning

confidence: 99%

The Impact of platelet–fibrin clot strength on occurrence and clinical outcomes of peripheral artery disease in patients with significant coronary artery disease

Bae

Ahn

Jang

et al. 2020

J Thromb Thrombolysis

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Patients with peripheral artery disease (PAD) have shown the increased risk of cardiovascular (CV) morbidity and mortality. This study sought to evaluate the impact of clot strength on prevalence and major adverse CV events (MACE) of PAD in high-risk patients. We enrolled patients undergoing percutaneous coronary intervention (PCI) (n = 1667) with available platelet-fibrin clot strength [thrombin-induced maximal amplitude (MA thrombin) measured by thromboelastography] and inflammation [high sensitivity C-reactive protein (hs-CRP)]. PAD was defined with abnormal ankle-brachial index (≤ 0.9 or > 1.4). MACE was defined as a composite of CV death, myocardial infarction or stroke. PAD was observed in 201 patients (12.1%). In the multivariate analysis, high clot strength [MA thrombin ≥ 68 mm: odds ratio (OR) 1.70, 95% confidence interval (CI) 1.20 to 2.41, p = 0.003] and enhanced inflammation (hs-CRP ≥ 3.0 mg/L: OR 2.30, 95% CI 1.56 to 3.41, p < 0.001) were associated with PAD occurrence. During the follow-up post-PCI (median, 25 months), MACE was more frequently occurred in patients with vs. without PAD (18.7% vs. 6.4% at 3 years; hazard ratio 1.72, 95% CI 1.03 to 2.87, p = 0.039). Furthermore, combined presence of PAD and high clot strength significantly increased the risk of MACE. In conclusion, this study is the first to show the impact of clot strength on prevalence and clinical outcomes of PAD in coronary artery disease patients undergoing PCI. Whether antithrombotic strategy according to level of this biomarker can improve clinical outcomes in PAD patients deserves the further study.

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Raised Fibrinogen Levels and Outcome in Outpatients With Peripheral Artery Disease

Cited by 22 publications

References 27 publications

Predictors of responders to mononuclear stem cell-based therapeutic angiogenesis for no-option critical limb ischemia

Predictors of responders to mononuclear stem cell-based therapeutic angiogenesis for no-option critical limb ischemia

Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

The Impact of platelet–fibrin clot strength on occurrence and clinical outcomes of peripheral artery disease in patients with significant coronary artery disease

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