Abstract
Introduction: Diagnosis of cardioembolic thrombosis is important because anticoagulant therapy is recommended for its secondary prevention. However, it is difficult to make a clear distinction in the pathogenesis between cardioembolic thrombosis and atherothrombosis. It has been reported that CD163 positive macrophage which related hemoglobin-haptoglobin complex was more involved in cardioembolic thrombus than atherothrombosis. Hypothesis: Erythrocyte morphology and its hemolysis in thrombus are associated with difference in thrombus formation between cardioembolic thrombosis and atherothrombosis. Methods: The Macrophage in Thrombus (MITO) study is an observational study examining pathological and biological differences of arterial thrombus between sinus rhythm (SR) and atrial fibrillation (AF). Patients with acute thromboembolic stroke (ATS) or ST elevation myocardial infarction (STEMI) whose solid thrombus could be retrieved from the infarct-related artery were enrolled. Patients were divided into 2 groups as follows; Group C; ATS with AF (presumed cardioembolic thrombosis) and Group A; STEMI with SR: (presumed atherothrombosis), and compared erythrocyte morphology score; 1: erythrocyte morphology is maintained; 2: The erythrocyte morphology is not maintained, but part of its fragment are seen; and 3: The erythrocyte morphology is not maintained at all in the thrombus seen by х40. Circulating blood counts (CBC), haptoglobin and soluble CD163 were measured all the patients. Results: The score of Group C (n=20) was significantly higher than that of Group A (n=28) (p<0.01)Figure. Laboratory findings are shown in the Table. Conclusions: Erythrocyte morphology disruption was thought to be more involved in cardioembolic thrombus formation. Erythrocyte morphology and CBC with soluble CD163 level are likely to help distinguish cardioembolic thrombus from atherothrombus.
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