THE INTENSITY OF THROMBIN FORMATION IN PATIENTS WITH CORONARY HEART DISEASE AFTER CORONARY STENTING

This study is aimed at exploring the use of thrombin generation assay (TGA) in platelet-poor plasma to assess the contribution of the protein C system to the hypercoagulation development in patients with coronary heart disease (CHD) after intracoronary stenting. The study material, the venous blood, was taken in 63 patients with CHD at the age of 53 to 77 before and on Day 1 after the planned percutaneous coronary intervention (PCI) who were treated with antiplatelet agents and antithrombotic agents in standard doses, and in 35 subjects of comparable age and sex without clinical manifestations of CHD who were not treated with these drugs for any other purpose. Laboratory examination included the standard coagulologic tests. To assess the effects of activated protein C system, the TGA in platelet poor plasma was modified by adding human recombinant trombomodulin (rh-TM) to the reaction mixture. The standard coagulologic tests revealed changes in hemostasis relevant to the pathogenesis of CHD and the effects of antithrombotic agents. The TGA results showed an increase in ETP and Peak Thrombin in patients with CHD after PCI with respect to the control and initial values which is evidence of the increased coagulation after the intervention. The test results also showed a reduction of TGA values per cent decline when adding TM. The ETR, Peak thrombin and ttPeak per cent decline was the most significant under the influence of TM which was evidence of the contribution of protein C activity reduction to the development of hypercoagulation after PCI. The modified TGA in platelet-poor plasma used in this study can be applied in clinical practice for estimating the plasma-coagulation hemostasis status and reduction in sensitivity to TM, which characterizes the protein C system activity by degree of decrease in results of the test that was performed in plasma without and with the addition of rh-TM.

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