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Blood, 15 October 2003, Vol. 102, No. 8, pp. 2731-2735. Prepublished online as a Blood First Edition Paper on July 3, 2003; DOI 10.1182/blood-2002-03-0954. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-03-0954v1 102/8/2731    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ardissino, D. Articles by Mannucci, P. M. Search for Related Content PubMed PubMed Citation Articles by Ardissino, D. Articles by Mannucci, P. M. Related Collections Hemostasis, Thrombosis, and Vascular Biology Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Coagulation activation and long-term outcome in acute coronary syndromes Diego Ardissino, Piera Angelica Merlini, Kenneth A. Bauer, Marcello Galvani, Filippo Ottani, Franca Franchi, Federico Bertocchi, Robert D. Rosenberg, and Pier Mannuccio Mannucci From the Division of Cardiology, Ospedale Niguarda Ca' Granda, Milan, Italy; Division of Cardiology, Ospedale Maggiore di Parma, University of Parma, Italy; Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and the Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Maggiore, University of Milan, Italy; Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA; Division of Cardiology, Ospedale Gian Battista Morgagni, Forli', Italy; and Division of Cardiology, Ospedale di Vicenza, Italy. After an episode of unstable angina or myocardial infarction, a high proportion of patients show biochemical signs of coagulation activation, expressed as persistently elevated thrombin generation, in their blood. It is not known whether this has any influence on long-term outcome. In this prospective multicenter cohort study, we assessed the relation of persistently elevated thrombin generation to outcome in 319 consecutive patients with acute coronary syndromes enrolled in the Global Use of Strategies To Open occluded coronary arteries (GUSTO) IIb trial. Plasma prothrombin fragment 1 + 2 levels, an index of "in vivo" thrombin generation, was measured during the acute phase and after 1, 6, and 12 months, and its relation to outcome was assessed during a median 29-month follow-up period. The primary end point of cardiac death or myocardial (re)infarction occurred in 61 patients (19%). There was a U-shaped relationship between plasma prothrombin fragment 1 + 2 levels and the risk of developing the primary end point; intermediate levels (1.5-1.9 nM) were associated with the lowest risk, whereas both higher (> 1.9 nM) and lower (< 1.5 nM) values were associated with an increased risk (relative risk [RR] 1.56 and 95% confidence interval [CI], 1.25-2.28; RR, 1.35 and 95% CI, 1.11-1.86, respectively). After an episode of acute coronary syndrome, both high and low levels of thrombin generation are predictors of an increased risk of an unfavorable outcome. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: L. M. Biasucci, M. Leo, and G. L. De Maria Local and Systemic Mechanisms of Plaque Rupture Angiology, August 1, 2008; 59(2_suppl): 73S - 76S. [Abstract] [PDF] P.E. Morange, C. Bickel, V. Nicaud, R. Schnabel, H.J. Rupprecht, D. Peetz, K.J. Lackner, F. Cambien, S. Blankenberg, L. Tiret, et al. Haemostatic Factors and the Risk of Cardiovascular Death in Patients With Coronary Artery Disease: The AtheroGene Study Arterioscler Thromb Vasc Biol, December 1, 2006; 26(12): 2793 - 2799. [Abstract] [Full Text] [PDF] E. M Antman The re-emergence of anticoagulation in coronary disease Eur. Heart J. Suppl., April 1, 2004; 6(suppl_B): B2 - B8. [Abstract] [Full Text] [PDF] L Wallentin Oral direct thrombin inhibition for anticoagulation in coronary artery disease - focus on the ESTEEM trial Eur. Heart J. Suppl., April 1, 2004; 6(suppl_B): B9 - B14. [Abstract] [Full Text] [PDF]

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