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2005, Number S3

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Arch Cardiol Mex 2005; 75 (S3)

Prothrombotic state in early stages of chronic Chagas’ disease. Its association with thrombotic risk factors

Herrera RN, Díaz E, Pérez AR, Bianchi J, Berman S, Luciardi HL

Language: Spanish
References: 70
Page: 38-48
PDF size: 109.65 Kb.


ABSTRACT

Objective: The aim of this study was to explore the presence of prothrombotic state in early stages of chronic Chagas’ disease with serum markers of thrombosis and fibrinolysis, and to investigate it´s association with thrombotic risk factors for venous thromboembolic disease. Patients and methods: Forty two patients with chronic Chagas’ disease were compared with 21 healthy volunteers. Thrombotic markers used were fragment 1 + 2, ATM complex, fibrinogen/fibrin degradation products, D-dimer and β-thromboglobulin. Fibrinolysis was evaluated with euglobulin lysis time, tissue plasminogen activator and it´s inhibitor levels. A thrombophilic screening was performed. Antithrombin and protein C were determined by functional methods, as well as free fraction of protein S, resistance to activated protein C, factor V Leiden R506Q mutation, prothrombin G20210A mutation, homocysteine and antiphospholipid antibodies: lupus and anticardiolipin antibodies isoforms IgG and IgM. Results: In chronic Chagas’ disease patients, statistically significant differences were observed in thrombotic markers: fragment 1 + 2 (p ‹ 0.0001), ATM complex (p ‹ 0.0001), fibrinogen/fibrin degradation products (p ‹ 0.05) and D-dimer (p ‹ 0.05). β-thromboglobulin did not reach statistically significant difference (p = 0.06). Statistically significant differences (p ‹ 0.0001) were found only in euglobulin lysis time, a non specific fibrinolytic marker. Specific fibrinolytic markers tissue plasminogen activator and it´s inhibitor, however, did not show statistically significant differences among studied groups. Conclusions: Eighty six percent of patients had positive thrombophilic screening for at least one thrombophilic risk factor. Thrombophilic risk factors were inherited in 39% and acquired in 83% of the patients.


REFERENCES

  1. Oliveira J, Correa de Araujo R, Navarro M, Muccillo G: Cardiac thrombosis and thromboembolism in chronic Chagas’ heart disease. Am J Cardiol 1983; 52: 147-151.

  2. Arteaga FE, Pereira BAC, Ianni BM, Mady C, Lopes EA, Brito VC, Bellotti G, Pileggi F: Trombose cardiaca e embolia em pacientes fallecidos de cardiopatia chagasica crónica. Arq Bras Cardiol 1989; 52(4): 189-192.

  3. Chant H, McCollum C: Stroke in young adults: the role of paradoxical embolism. Thromb Haemost 2001; 85(1): 22-229.

  4. Carrasco GH, Avilan L, Barboza J, Fuenmayor A, Dávila D, Pérez T: Enfermedad tromboembólica pulmonar y de los miembros inferiores en los pacientes con insuficiencia cardíaca congestiva global crónica. Arch Inst Cardiol Mex 1978; 48(1): 214-232.

  5. Braga J, Labrunie A, Villaca F, do Nascimento E, Quijada L: Thromboembolism in chronic Chagas´ heart disease. Rev Paul Med 1995; 113(2): 862-66.

  6. Roldan SV, Marin OF, Pineda RJ, Climente PV, Martinez MJ, Marco VP, et al: Thrombogenic and endothelial damage markers in patients with ischemic systolic impairment. Rev Esp Cardiol 2001; 54(10): 1155-60.

  7. Lip G, Gibbs C: Does Heart failure confer a hypercoagulable state? Virchow´s triad revisited. J Am Coll Cardiol 1999; 33(5): 1424-26.

  8. Puigbo J, Giordano H, Suarez C, Acquatella H, Combellas I: Aspectos clínicos en la enfermedad de Chagas. En: Madoery RJ, Madoery C, Camera MI eds. Actualizaciones en la enfermedad de Chagas. Buenos Aires: Organismo oficial del Congreso Nacional de Medicina 1992: 27-38.

  9. Pujol A: Vasos periféricos y linfáticos. En: Doménech Torné SM, Setoain J, Galofé P, Cedo J, Garcia Alonso MC, Herranz R, Luque MT, Martín J, Monné J, Ortega D, Penna F, Piera C, Pujol A, Ramos M, Ruibal A. Medicina nuclear. Aplicaciones diagnósticas de los isótopos radiactivos. Series Monográficas Médicas. Medicina Nuclear. Barcelona. Editorial Científica Médica. 1980: 175-184.

  10. The PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA 1990; 263(20): 2753-59.

  11. Feigenbaum H: Masas cardíacas. En: Feigenbaum H. Ecocardiografía. 5a edición: Buenos Aires, Argentina. Editorial Médica Panamericana. 1994: 569-607.

  12. Yamamoto K, Saito H: Diagnosis of predictive state of diseminated intravascular coagulation. Nippon Rinsho 1993; 51(1): 74-78.

  13. Roldan V, Marin F, Marco P, Climent V, Martinez JG, Monmeneu JV, et al: Anticoagulant therapy modifies fibrinolytic dysfunction in chronic atrial fibrillation. Haemostasis 2000; 30(4): 219-224.

  14. Von Kaulla K, von Kaulla E: Remarks on the euglobin lysis. En: Davidson J, Samana M, Desmoyers P eds. Progress in chemical fibrinolysis and thrombolysis. New York. Daven Press 1975: 131-149.

  15. Blanco A, Nadal MV, Salviú MJ: Evaluación del mecanismo fibrinolítico. En: Kordich L. Ed. Jefe. Fundamentos para el manejo práctico en el laboratorio de hemostasia. Grupo CAHT. Buenos Aires. Editorial Federación Bioquímica 2003: 425-469.

  16. College of American Pathologists Consensus Conference XXXVI: Diagnostic Issues in Thrombophilia. Arch Pathol Lab Med. 2002; 126(11): 1277-433.

  17. Wilson WA, Gharavi AE, Koike T, Lockshin MD, Branch DW, Piette JC, et al: International consensus statement on preliminary classification criteria for definitive antiphospholipid syndrome. Arthritis Rheum 1999; 42: 1309-1311.

  18. Brandt J, Tripplett D, Alving B, Scharrer I: Criteria for the diagnosis of lupus anticoagulants: update. Thromb Haemost 1995; 74: 1185-1190.

  19. Espinoza R, Carrasco H, Belandria F, Fuenmayor A, Molina C, Martinez O: Life expectancy analysis in patients with Chagas´ disease: prognosis after one decade (1973-1983). Intern J Cardiol 1985; 8: 45-47.

  20. Hagar JM, Rahimtoola SH: Chagas’ Heart Disease. Curr Probl Cardiol, 1995; XX(12): 825-924.

  21. Rouvier J, Scazziota A: Factores y Marcadores de Riesgo de Trombosis. En: Altman R, Aznar J, Rouvier J, Scazziota A, Reussi R eds. Cuadernos de Trombosis Tomo I. Buenos Aires. Infomed 1999: 39-40.

  22. Rosemberg R, Aird W: Vascular bed-specific hemostasis and hypercoagulable states. N Engl J Med 1999; 340(20): 1555-1564.

  23. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, Melton LJ 3rd: The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001; 86: 452-463.

  24. Levine MN, Hirsh J, Gent M, Turpie AG, Weitz J, Ginsberg J, Geerts W, LeClerc J, Neemeh J, Powers P: Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb Haemost 1995; 74: 606-611.

  25. Prandoni P, Lensing AW, Prins MH, Bernardi E, Marchiori A, Bagatella P, et al: Residual vein thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 2002; 137(12): 955-60.

  26. Piovella F, Crippa L, Barone M: Normalization rate of compression ultrasonography in symptomatic vs post-surgical acute deep vein thrombosis. Thromb Haemost 2001; 86(Suppl): OC 43.

  27. Palareti G, Legnani C, Cosmi B, Guazzaloca G, Pancani C, Coccheri S: Risk of venous thromboembolic recurrence: high negative predictive value of D-dimer performed after oral anticoagulation is stopped. Thromb Haemost 2002; 87: 7-12.

  28. Crowther MA, Roberts J, Roberts R, Johnston M, Stevens P, Skingley P, et al: Fibrinolytic variables in patients with recurrent venous thrombosis: a Prospective Cohort Study. Thromb Haemost 2001; 85: 390-394.

  29. Murin S, Romano P, White R: Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism. Thromb Haemost 2002; 88: 407-414.

  30. Tsai AW, Cushman M, Rosamond WD, Heckbert SR, Tracy RP, Aleksic N, Folsom AR: Coagulation Factors, Inflammation Markers, and Venous Thromboembolism: The Longitudinal Investigation of Thromboembolism Etiology (LITE). Am J Med 2002; 113: 636-642.

  31. Herrera RN, Amaya E, Vinciguerra R, Coviello A, Sant-Yacumo R, de la Serna F, et al: Estado protrombótico en pacientes chagásicos crónicos. Rev Fed Arg Cardiol 2001; 30: 457-467.

  32. Herrera RN, Diaz E, Perez R, Chain S, Sant-Yacumo R, Rodriguez E, et al: Estado protrombótico en estadios tempranos de la enfermedad de Chagas crónica. Rev Esp Cardiol 2003; 56(4): 377-382.

  33. Egeberg O: Inherited antithrombin deficiency causing thrombophilia. Thromb Diath Haemorrh 1965; 13: 516-530.

  34. Lane DA, Mannucci PM, Bauer KA, Bertina RM, Bochkov NP, Boulyjenkov V, et al: Inherited thrombophilia: Part 1. Thrombosis and Haemostasis 1996; 76(5): 651-662.

  35. Lane DA, Mannucci PM, Bauer KA, Bertina RM, Bochkov NP, Boulyjenkov V, et al: Inherited thrombophilia: Part 2. Thrombosis and Haemostasis 1996; 76(6): 824-834.

  36. Bertina R: Genetic Approach to thrombophilia. Thromb Haemost 2001; 86:92-103.

  37. Ratnoff O, Forbes Ch: The hipercoagulable state. En: Bawer K editor. Disorders of haemostasis: 3rd Philadelphia. WB Saunders Co. 1996: 228-258.

  38. Van Cott E, Laposata H, Prins M: Laboratory evaluation of hypercoagulability with venous or arterial thrombosis. Arch Pathol Lab Med 2002; 126: 1281-1295.

  39. Olson J: College of American Pathologists Consensus Conference XXXVI: Diagnostic Issues in Thrombophilia: Arch Pathol Lab Med 2002; 126: 1277-1280.

  40. Jorg M, Storino R, Bergoglio E: Correlación de la hiperhomocisteinemia con la gravedad evolutiva de la cardiopatía en la enfermedad de Chagas. Prensa Méd Argent 1998; 85: 84-91.

  41. Key L, Mc Glennen R: Hyperhomocyst(e)inemia and Thrombophilia. Arch Pathol Lab Med 2002; 126: 1319-1325.

  42. Chan WP, Lee CK, Kwong YL, Lam CK, Liang R: A novel mutation of Arg 306 of factor V gene in Hong Kong Chinese. Blood 1998; 91: 1135-1139.

  43. Williamson D, Brown K, Luddington R, Baglin C, Baglin T: Factor V Cambridge: a new mutation (Arg 306-Thr) associated with resistance to activated protein C. Blood 1998; 91: 1140-1144.

  44. Meinardi JR, Henkens CM, Heringa MP, van der Meer J: Acquired APC resistance related to oral contraceptives and pregnancy and its possible implication for clinical practice. Blood Coagul Fibrinolysis 1997; 8(2): 152-154.

  45. Press RD, Bauer KA, Kujovich JL, Heit JA: Clinical utility of Factor V Leiden (R506Q) Testing for the Diagnosis and Management of Thromboembolic Disorders. Arch Pathol Lab Med 2002; 126: 1303-1318.

  46. De Visser MC, Rosendaal FR, Bertina RM: A reduced sensitivity for activated protein C in the absence of factor V Leiden increases the risk of venous thrombosis. Blood 1999; 93: 1271-1276.

  47. Rodeghiero T, Tosetto A: Activated protein C resistance and factor V Leiden mutation are independent risk factor for venous thromboembolism. Ann Intern Med 1888; 130: 643-650.

  48. Curvers J, Thomassen MC, Rimmer J, Hamulyak K, van der Meer J, Tans G, et al: Effect of hereditary and acquired risk factors of venous thrombosis on a thrombin generation-based APC resistance test. Thromb Haemost 2002; 88: 5-11.

  49. De Visser MC, Guasch JF, Kamphuisen PW, Vos HL, Rosendaal FR, Bertina RM: The HR2 haplotype of factor V: Effects and Factor V levels, normalized activated protein C sensitivity ratios and the risk of venous trombosis. Thromb Haemost 2000; 83: 577-582.

  50. Faioni EM, Franchi F, Bucciarelli P, Margaglione M, de Stefano V, Castaman G, et al: Coinheritance of the HR2 haplotype in the factor V gene confers an increased risk of venous thromboembolism to carriers of factor V R506Q (factor V Leiden). Blood 1999; 94: 3062-3066.

  51. Mc Glennen R, Key L: Clinical and Laboratory Management of the Prothrombin G20210A Mutation. Arch Pathol Lab Med 2002; 126: 1319-1325.

  52. Ginsburg KS, Liang MH, Newcomer L, Goldhaber SZ, Schur PH, Hennekens CH, Stampfer MJ: Anticardilipin antibodies and the risk for ischemic stroke and venous thrombosis. Ann Int Med 1992; 117: 997-1002.

  53. Schulman S, Svenungsson E, Granqvist S: Anticardilipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. The Duration of Anticoagulation Study Group. Am J Med 1998; 104: 332-338.

  54. Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J: Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism-results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost 1997; 77: 444-451.

  55. Galli M, Finazzi G, Duca F, Norbis F, Moia M: The G1619A mutation but not the G20210A mutation of factor II or the C6771 mutation of methylenetetrahydrofolate reductase genes, is associated with deep venous thrombosis in patients with lupus anticoagulants. Br J Haematol 2000; 108: 865-870.

  56. Eschwege V, Peynaud-Debayle E, Wolf M, Amiral J, Vissac AM, Bridey F, et al: Prevalence of antiphospholipid-related antibodies in unselected patients with history of venous thrombosis. Blood Coagul Fibrin 1998; 9: 429-434.

  57. Salomon O, Steinberg DM, Zivelin A, Gitel S, Dardik R, Rosenberg N, et al: Single and combined prothrombotic factors in patients with idiopathic venous thromboembolism: prevalence and risk assessment. Arterioscl Thromb Vasc Biol 1999; 19: 511-518.

  58. Zanon E, Prandoni P, Vianello F, Saggiorato G, Carraro G, Bagatella P, Girolami A: Anti-beta 2 glycoprotein 1 antibodies in patients with acute venous thromboembolism: prevalence and association with recurrent thromboembolism. Thromb Res 1999; 96: 269-274.

  59. Palosuo T, Virtamo J, Haukka J, Taylor PR, Aho K, Puurunen M, Vaarala O: High antibody levels to prothrombin imply a risk of deep venous thrombosis and pulmonary embolism in middle aged men a nested case-control study. Thromb Haemost 1997; 78; 1178-1182.

  60. Cuadrado MJ, Lopez-Pedrera C, Khamashta MA, Camps MT, Tinahones F, Torres A, et al: Trombosis in primary fosfolipid syndrome: A pivotal rol for monocyte tissue factor expression. Arthritis Rheum 1997; 40: 834-841.

  61. Worrall J, Snaith M, Batchelor J, et al: SLE: a rheumatologic view. Analysis of the clinical features, serology and immunogenetics in 100 SLE patients during long term follow up. Q J Med 1990; 74: 319-330. Worrall JG, Snaith ML, Batchelor JR, Isenberg DA: SLE: a rheumatologic view. Analysis of the clinical features, serology and immunogenetics in 100 SLE patients during long term follow up. Q J Med 1990; 74: 319-330.

  62. Bick R, Kaplan H: Syndromes of thrombosis and hypercoagulability. Congenital and Acquired causes of thrombosis. Med Clin North Am 1998; 82: 409-458.

  63. Forastiero R, Martinuzzo M, Carreras L: Estados trombofílicos congénitos y adquiridos. En: Battagliotti C, Bertolaccini M, Pons-Estel B, Carreras L. Síndrome Antifosfolipídico. Actualización clínica y terapéutica. Rosario, Argentina. Imprenta editorial La Familia 2002: 105-138.

  64. Pierangeli SS, Colden-Stanfield M, Liu X, Barker JH, Anderson GL, Harris EN: Antiphospholipid antibodies from antiphospholipid syndrome patients activate endothelial cells in vitro and in vivo. Circulation 1999; 99: 1997-2002.

  65. Bertolaccini M, Bertolaccini D: Mecanismos patogénicos en el síndrome antifosfolipídico. En: Battagliotti C, Bertolaccini M, Pons-Estel B, Carreras L. Síndrome antifosfolipídico. Actualización clínica y terapéutica. Rosario, Argentina. Imprenta Editorial La Familia 2002: 26-33.

  66. Harris A, Rosenberg A, Riedel L: A microfoculation test for syphilis using cardiolipin antigen. J Vener Dis Inf 1946; 27: 169-174.

  67. Britto C, Cardoso MA, Vanni CM, Hasslocher-Moreno A, Xavier SS, Oelemann W, et al: Polymerase chain reaction on detection of Trypanosoma cruzi in human blood samples as a tool for diagnosis and treatment evaluation. Parasitology 1995; 110: 241-247.

  68. Tarleton R: Parasite persistence in the etiology of Chagas disease. Int J Parasitol 2001; 31: 550-554.

  69. Salomone O: Miocardiopatía chagásica y trombosis: el principio y el final de una relación peligrosa. Rev Esp Cardiol 2003; 56(4): 333-334.

  70. Coon W: Risk factors in pulmonary embolism. Surg Gynecol Obstet 1976; 143: 385-390.




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