Procoagulatory Changes in Patients with Chronic Lower Limb Ischemia

K. Komissarov¹, V. Soldatenkov², L. Papayan³, S. Bessmeltsev¹, N. Silina¹, S. Kapustin², V. Burakov¹, N. Saltykova¹, O. Kuzakbirdieva¹, O. Matvienko⁴, O. Soldatenkova¹

¹Russian Scientific Research Institute of Hematology and Transfusiology, Saint-Petersburg, Saint Petersburg City, Russia, ²Russian Research Institute of Hematology and Transfusiology, Saint Petersburg, Saint Petersburg City, Russia, ³Russian Research Institute of Haematology and Transfusiology, Saint Petersburg, Saint Petersburg City, Russia, ⁴Russian Research Institute of Hematology and Transfusiology, Saint-Petersburg, Saint Petersburg City, Russia

Abstract Number: VPB0524

Meeting: ISTH 2022 Congress

Theme: Arterial Thromboembolism » Peripheral Artery Disease

Background: The risk factors for unfavorable peripheral artery disease (PAD) course and treatment failure in young patients are still unrevealed. One of the most promising research areas is the assessment of procoagulatory changes in these patients.

Aims: To determine the prognostic value of procoagulatory markers in patients with chronic lower limb ischemia.

Methods: We examined 17 patients under the age of 55 with chronic arterial insufficiency (stages IIa-III according to Fontaine classification) and popliteal and tibial artery thrombosis and/or popliteal-to-distal bypass graft thrombosis. The following assays were performed: aPTT, PTI, thrombin time; antithrombin III, protein C, protein S, factor VIII (FVIII), factor IX (FIX) and von Willebrand factor (VWF) activity levels assessment; determination of homocysteine and fibrinogen plasma levels; testing for antiphospholipid antibodies; molecular genetic testing for inherited thrombophilia (FII, FV, FI, PAI-1, GpIb, GpIIIa, MTHFR).

Results: The most unfavorable course of PAD accompanied by migratory thromboses of distal arterial segments, arterial bypass grafts thromboses, tissue loss was observed in 6 (35.3%) patients with the FI gene mutation 455G/A, which led to the persistent increase in fibrinogen plasma level (the average level was 4.57 g/l). In a single case, the combination of prothrombin gene mutation G20210A and FI gene mutation 455G/A determined the failure of reconstructive surgery and increased number of early post-operative arterial and bypass grafts thromboses.

In 9 (53%) subjects, the increased levels of FVIII and VWF activity were found.

Conclusion(s): The procoagulatory changes (FI gene mutation 455G/A with hyperfibrinogenemia, prothrombin gene mutation G20210A, elevation of FVIII and VWF activity levels) in patients with chronic lower limb ischemia may be predictors of unfavorable PAD course and failure of reconstructive interventions, and may require early, intensive and prolonged antithrombotic therapy.

To cite this abstract in AMA style:

Komissarov K, Soldatenkov V, Papayan L, Bessmeltsev S, Silina N, Kapustin S, Burakov V, Saltykova N, Kuzakbirdieva O, Matvienko O, Soldatenkova O. Procoagulatory Changes in Patients with Chronic Lower Limb Ischemia [abstract]. https://abstracts.isth.org/abstract/procoagulatory-changes-in-patients-with-chronic-lower-limb-ischemia/. Accessed September 29, 2023.

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