Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

Background Coagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. In this study we aimed to assess the coagulation and platelet state in IE implementing a wide range of standard and global laboratory assays. We also aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients. Methods 37 patients with IE were enrolled into the study. Coagulation was assessed using standard coagulation assays (activated partial thromboplastin time (APTT), prothrombin, fibrinogen, D-dimer concentrations) and integral assays (thromboelastography (TEG) and thrombodynamics (TD)). Platelet functional activity was estimated by flow cytometry. Single nuclear polymorphisms of coagulation system genes were studied. Results Fibrinogen concentration and fibrinogen-dependent parameters of TEG and TD were increased in patients indicating systemic inflammation. In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation. However, in some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation. Resting platelets were characterized by glycoprotein IIb-IIIa activation and degranulation. In patients with fatal IE, we observed a significant decrease in fibrinogen and thrombodynamics. In patients with embolism, we observed a significant decrease in the TEG R parameter. No association of embolism or mortality with genetic polymorphisms was found in our cohort. Conclusions Our findings suggest that coagulation in patients with infective endocarditis is characterized by general hypercoagulability and platelet pre-activation. Some patients, however, have hypocoagulant coagulation profile, which presumably can indicate progressing of hypercoagulation into consumption coagulopathy. © 2021 Koltsova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Koltsova E.M.1, 2 , Sorokina M.A. 1 , Pisaryuk A.S. 3, 4 , Povalyaev N.M. 3, 4 , Ignatova A.A. 1, 2 , Polokhov D.M.1 , Kotova E.O. 4 , Balatskiy A.V.5 , Ataullakhanov F.I.1, 2, 5, 6 , Panteleev M.A.1, 2, 5, 6 , Kobalava Z.D. 4 , Balandina A.N.1, 2
Public Library of Science
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12 December
  • 1 Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
  • 2 Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russian Federation
  • 3 City Clinical Hospital named after V.V. Vinogradov, Moscow, Russian Federation
  • 4 Peoples’ Friendship University of Russia (RUDN), Moscow, Russian Federation
  • 5 Lomonosov Moscow State University, Moscow, Russian Federation
  • 6 Moscow Institute of Physics and Technology, Dolgoprudny, Russian Federation
Ключевые слова
D dimer; fibrinogen; glycoprotein IIb; glycoprotein IIIa; prothrombin; fibrin degradation product; fibrin fragment D; fibrinogen; prothrombin; activated partial thromboplastin time; adult; aged; Article; artificial embolization; bacterial endocarditis; blood clotting disorder; blood examination; clinical article; cohort analysis; controlled study; degranulation; disease exacerbation; female; fibrinogen blood level; flow cytometry; gene identification; genetic polymorphism; growth rate; hematological parameters; hemostasis; human; hypercoagulability; laboratory test; male; mortality; observational study; prothrombin time; single nucleotide polymorphism; thrombocyte function; thrombodynamic; thromboelastography; endocarditis; genetics; hemostasis; middle aged; partial thromboplastin time; pathology; physiology; procedures; thrombocyte; thrombocyte activation; thrombophilia; Adult; Aged; Blood Platelets; Endocarditis; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hemostasis; Humans; Male; Middle Aged; Partial Thromboplastin Time; Platelet Activation; Polymorphism, Single Nucleotide; Prothrombin; Thrombelastography; Thrombophilia
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