VPB0524 - Procoagulatory Changes in Patients with Chronic Lower Limb Ischemia

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Co-Author(s)

KK

Kirill Komissarov

Junior researcher
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia

Presenting Author(s)

VS

Vitaly Soldatenkov, PhD, MD

Head of the Surgery Department
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia

Co-Author(s)

LP

Lyudmila Papayan

head of blood coagulation laboratory
Russian Research Institute of Haematology and Transfusiology
Saint Petersburg, Saint Petersburg City, Russia
SB

Stanislav Bessmeltsev

Head of the Research Department
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia
NS

Natalya Silina

Head of the Hemostasis pathology department
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia
Sergey Kapustin, PhD

Leading Researcher
Russian Research Institute of Hematology and Transfusiology
Saint Petersburg, Saint Petersburg City, Russia
VB

Viacheslav Burakov

Senior researcher
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia
NS

Natalya Saltykova

Surgeon
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia
OK

Oksana Kuzakbirdieva

Junior researcher
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia
OM

Olesia Matvienko

leader researcher
RUSSIAN RESEARCH INSTITUTE OF HEMATOLOGY AND TRANSFUSIOLOGY
Saint-Petersburg, Saint Petersburg City, Russia
OS

Olga Soldatenkova

Junior researcher
Russian Scientific Research Institute of Hematology and Transfusiology
Saint-Petersburg, Saint Petersburg City, Russia

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.