Abstract
BackgroundBehçet disease (BD) is associated with a prothrombotic state of unknown origin that may lead to life-threatening events. Calibrated Automated Thrombogram (CAT) and Rotational Thromboelastometry (ROTEM) are two global haemostasis assays that may reveal new insights into the physiopathological mechanisms of the disease and its procoagulant condition.Methods23 BD patients who had no signs or symptoms of current thrombosis and 33 age- and sex-matched controls were included in the study. We performed ROTEM and CAT tests and assessed erythrocyte count, platelet count, platelet contribution to clot formation and plasma levels of tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), fibrinogen, C-reactive protein (CRP), thrombin-antithrombin III complex (TAT), D-dimer and E-selectin (ES).ResultsBoth ROTEM and CAT tests showed a hypercoagulable state in the BD patients. Plasma levels of PAI-1, fibrinogen, TAT, CRP and ES were significantly increased in this group compared to controls. The disease activity (DA) was significantly correlated with levels of ES and the maximum clot firmness, and this last one, in turn, correlated with rising levels of ES, PAI-1, CRP and fibrinogen. CAT parameters did not correlate with DA or ES.ConclusionsBoth ROTEM and CAT tests reveal that patients with BD have a procoagulant state even in the absence of thrombosis. ROTEM test indicates that increased levels of fibrinogen and PAI-1 may be involved in the prothrombotic state of this pathology, while platelets do not significantly contribute. Moreover, CAT assay demonstrate that plasma from BD patients is able to generate more thrombin than controls in response to the same stimulus and that this effect is independent of the DA and the endothelial impairment suggesting the involvement of another factor in the hypercoagulable state observed in BD patients. This study also shows that endothelium activation/damage may be a contributing factor in both the procoagulant and clinical conditions of BD, as shown by the direct correlation between ES levels, ROTEM parameters and DA.
Highlights
Behçet’s disease (BD), known as Adamantiades– Behçet's disease, is a rare multisystem, inflammatory disease of unknown aetiology [1] and is associated with thrombogenicity [2]
Biochemistry and study of fibrinolysis We found significantly increased levels of fibrinogen, C-reactive protein (CRP), plasminogen activator inhibitor type 1 (PAI-1) antigen, thrombin-antithrombin III complex (TAT) and ES in the Behçet disease (BD) patients (Table 2)
We observed that fibrinogen levels were significantly correlated with INTEM-Maximum clot firmness (MCF) in both patients and controls, which suggests that increased levels of fibrinogen in the BD group might be involved in the group’s hypercoagulable profile, as determined by the Rotational Thromboelastometry (ROTEM) test
Summary
Behçet’s disease (BD), known as Adamantiades– Behçet's disease, is a rare multisystem, inflammatory disease of unknown aetiology [1] and is associated with thrombogenicity [2]. New international criteria [3] have recently been published as diagnostic criteria for BD and include vascular manifestations, which is of great importance due to the frequency of serious vascular and large vessel involvement as has been recently reported [4]. The pathogenesis of the prothrombotic state in BD is not known, associated vascular damage/activation seems to be an important key factor [6,7]. Behçet disease (BD) is associated with a prothrombotic state of unknown origin that may lead to life-threatening events. Calibrated Automated Thrombogram (CAT) and Rotational Thromboelastometry (ROTEM) are two global haemostasis assays that may reveal new insights into the physiopathological mechanisms of the disease and its procoagulant condition
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