Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Abstract

peripheral arterial disease (pad) has often underlying risk factors, of which diabetes and cigarette smoking are the most common. enhanced platelet activation and interaction with vessel wall associate with atherothrombotic disease, but also increased fibrinogen levels, thrombin generation and fibrin turnover are typical for pad. the pathogenic role of fibrinogen, thrombin formation and fibrin degradation is suggested not only in acute thrombotic complications, but also in the stable form of pad, where these markers associate with the functional severity (ankle-brachial blood pressure index). the coagulation-specific etiologies of pad should be suspected if the atherothrombotic disease has severe manifestations, especially while the traditional risk factors are absent, or if the patient has also a history of venous thromboembolism. malignant disease may be present in form of peripheral arterial thrombosis as well. thrombophilia may expose patients to idiopathic thrombosis -both spontaneously and after vascular interventions. the management of these patients includes often combination therapies with antiplatelet agents and anticoagulants. obviously, the strict policy to avoid risk factors and to treat them well in avoidance of progression of arterial disease is highly important. in the absence of published follow-up data the evidence to support the management strategies is weak and individual tailoring of efficacious and safe antithrombotic drug therapy remains our challenge. these patients benefit from continuous medical attention by the experts in the field of angiology. management of pad is an excellent example of the multidisciplinary approach where the hematologist meets the vascular surgeon or interventional radiologist to secure the best available patient care.

Crystal structure of (S)-5-chloro-N-({2-oxo-3-[4-(3-oxomorpholin-4-yl)phenyl]oxazolidin-5-yl}methyl)thiophene-2-carboxamide

“…At present, the incidence of thromboic disease is extremely high; this is mainly caused by vascular endothelial injury, increased blood coagulation, increased platelet number and decreased anticoagulant activity (Lassila, 2012). In anticoagulants, warfarin and heparin have dominated the market, but they have some defects such as making making patients bleed easily and be prone to thrombocytopenia and osteoporosis (Mega & Carreras, 2012).…”

Diagnostic morphology: biophysical indicators for iron-driven inflammatory diseases

“…This tighter clot is therefore due to a general ''hypercoagulability'' also known as a prothrombotic state, and an increased fibrinogen level is associated with hypercoagulability. 168 Almost all inflammatory conditions are characterized by a hypercoagulable state, and this state may result in thrombotic events including thrombotic ischemic stroke. 169 Hypercoagulability is also present in diabetes type II, rheumatoid arthritis, heart conditions and other inflammatory conditions.…”

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

“…It is well known that coagulation activation and endothelial stimulation are significantly increased in patients with PAD, and these factors are intimately related with the severity of the arterial disease [1]. Besides, elevated platelet activation, altered fibrinogen levels, thrombin generation, and fibrin turnover are typical in PAD [2]. These patients, especially those with critical limb threatening ischemia, present decreases in natural anticoagulants (proteins C and S) and coagulation factors FIX, FXI, and FXII [3].…”