Abstract
Fibrin is a major component of thrombi formed on the surface of atherosclerotic plaques. Fibrin accumulation as a consequence of local blood coagulation activation takes place inside atherosclerotic lesions and contributes to their growth. The imbalance between thrombin-mediated fibrin formation and fibrin degradation might enhance atherosclerosis in relation to inflammatory states reflected by increased fibrinogen concentrations, the key determinant of fibrin characteristics. There are large interindividual differences in fibrin clot structure and function measured in plasma-based assays and in purified fibrinogen-based systems. Several observational studies have demonstrated that subjects who tend to generate denser fibrin networks displaying impaired clot lysis are at an increased risk of developing advanced atherosclerosis and arterial thromboembolic events. Moreover, the majority of cardiovascular risk factors are also associated with unfavorably altered fibrin clot properties, with their improvement following effective therapy, in particular with aspirin, statins, and anticoagulant agents. The prothrombotic fibrin clot phenotype has been reported to have a predictive value in terms of myocardial infarction, ischemic stroke, and acute limb ischemia. This review article summarizes available data on the association of fibrin clot characteristics with atherosclerotic vascular disease and its potential practical implications.
Highlights
Growing evidence indicates that the formation of denser fibrin networks, which are less susceptible to lysis, characterizes patients with atherosclerosis and arterial thromboembolic events
Reduced fibrin clot permeabilbotic fibrin clot phenotype, which is associated with lower fibrin fiber diameter, lower pore size area, and increased numity (Ks ) is a typical feature of the prothrombotic fibrin clot phenotype, which is associated with lower ber of fibrin branch points
We have identified a thin layer of a fibrin biofilm on the surface of 15% intracoronary thrombi from acute Myocardial infarction (MI) patients, which was solely associated with higher plasma fibrinogen levels [60]
Summary
Growing evidence indicates that the formation of denser fibrin networks, which are less susceptible to lysis, characterizes patients with atherosclerosis and arterial thromboembolic events. Several cardiovascular risk factors, such as hyperlipidemia, hypertension, smoking, or diabetes have been shown to be associated with unfavorably altered fibrin clot properties in the general population. Low-dose aspirin, statins, better diabetes control, or smoking cessation have been shown to increase fibrin clot permeability and its susceptibility to lysis. It has been shown that non-vitamin K antagonist oral anticoagulants (NOACs) are able to improve fibrin clot characteristics and contribute to the reduced risk of adverse clinical outcomes. The current review article summarizes available basic research and clinical papers deposited on PubMed over the last decade regarding associations between fibrin clot phenotype and atherosclerotic vascular disease, supported by the seminal papers from previous years. Data on novel therapeutic strategies, which can potentially influence fibrin clot characteristics, have been discussed
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