PLATELET-FUNCTION, THROMBIN AND FIBRINOLYTIC-ACTIVITY IN PATIENTS WITH HEART-FAILURE

Assays which detect the release of platelet-specific proteins and of peptides during thrombogenesis and are considered markers of activation of platelets and the coagulation system have recently been developed. This study was designed to utilize these haemostasis-related markers to test the hypothesis that a prethrombotic state is related to the presence, aetiology and severity of heart failure. Seventy patients with heart failure were evaluated and data were compared with 36 normal volunteers and 41 patients with coronary artery disease without heart failure (CAD). Thrombogenesis was documented using assays which measure platelet function, thrombin activity and fibrinolysis. Platelet function was measured by determining plasma concentrations of platelet factor 4 (PF4) and beta-thromboglobulin (BTG). Thrombinantithrombin III complexes (TAT) and fibrinopeptide A (FPA) were determined to evaluate thrombin activity. Fibrinolytic activity was assessed by measuring D-Dimer levels. Patients with heart failure, when compared to normals, had increased plasma levels of BTG (89±62IU . ml-1 vs 50±59 IU . ml-1, P < 0.01), TAT (4.6 ± 4.3 μg . l-1 vs 2.3 ± 0.64 μg . l-1, P < 0.005), and D-Dimer levels (506±444 IU . ml-1 vs 191 ± 144 IU . ml-1, P ± 0.0001). Patients with heart failure, when compared to the CAD group, had increased plasma levels of D-Dimer (506±444 ng . ml-1 vs 191±144 ng . ml-1, P < 0.05). Aetiology of heart failure did not affect these measurements. Patients with severe heart failure, as determined by high plasma norepinephrine concentration or low ejection fraction, were more likely to have activation of platelets and the coagulation system. Our study indicates that patients with heart failure have evidence of increased platelet and thrombin activation and fibrinolytic activity. These abnormalities are most pronounced in patients with severe heart failure. © 1993 The European Society of Cardiology.