Abstract Number: PB1820
Meeting: ISTH 2020 Congress
Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for cardiovascular events, particularly following an acute exacerbation (AE-COPD). Exacerbations are associated with increased systemic inflammation, which may drive coagulation.
Aims: This prospective cohort study aimed to determine the effects of an AE-COPD on platelet activation, the endothelium and plasmatic coagulation, and its association with systemic inflammation.
Methods: This study was approved by the Maastricht University Medical Centre ethics committee. Fifty-two patients with an AE-COPD were included. After informed consent, blood samples were taken during AE-COPD, at day 3 of treatment and at convalescence (for 32 patients). Platelet-monocyte complex (PMC) formation, monocyte activation (Mac-1 expression) and platelet (re)activity (P-selectin expression, GPIIbIIIa activation) were measured by flow cytometry. Von Willebrand Factor (VWF) and thrombin generation (TG) were determined as measures of endothelial activation and plasmatic coagulation, respectively.
Results: Acute exacerbations of COPD were associated with increased PMCs compared to convalescence (MFI 31.3 vs 23.8, p=0.004). Increased PMC formation was not accompanied by changes in platelet function. Secondly, VWF antigen, activity and the active VWF fraction were significantly higher during AE-COPD (medians 218%, 157%, 151%, respectively) compared to convalescence (182%, 135%, 125%, respectively). Thirdly, thrombin generation peak, ETP and velocity index were significantly elevated during AE-COPD compared to convalescence. PMC formation, VWF and thrombin generation were positively associated with the inflammatory marker CRP. Moreover, platelet hyperreactivity on admission was associated with an increased risk for exacerbation relapse.
Conclusions: In conclusion, acute exacerbations induce an inflammation-associated prothrombotic state, characterized by increased PMCs, endothelial activation and plasmatic coagulation. These findings provide direction for future studies on markers that predict the risk of cardiovascular events and guide thromboprophylaxis.
To cite this abstract in AMA style:van der Vorm LN, Li L, Huskens D, Hulstein J, Roest M, de Groot PG, ten Cate H, de Laat B, Remijn J, Simons S. Acute Exacerbations of COPD Induce a Prothrombotic State through Platelet-Monocyte Complexes, Endothelial Activation and Increased Thrombin Generation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/acute-exacerbations-of-copd-induce-a-prothrombotic-state-through-platelet-monocyte-complexes-endothelial-activation-and-increased-thrombin-generation/. Accessed May 6, 2021.
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