Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

Ekaterina M Koltsova,Dmitry M Polokhov,Nikita M Povalyaev,Fazoil I Ataullakhanov,Mikhail A Panteleev,Anna N Balandina,Anastasia A Ignatova,Maria A Sorokina,Zhanna D Kobalava,Alexandra S Pisaryuk,Alexander V Balatskiy,Elizaveta O Kotova,Cécile Oury

doi:10.1371/journal.pone.0261429

Abstract

BackgroundCoagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. In this study we aimed to assess the coagulation and platelet state in IE implementing a wide range of standard and global laboratory assays. We also aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients.Methods37 patients with IE were enrolled into the study. Coagulation was assessed using standard coagulation assays (activated partial thromboplastin time (APTT), prothrombin, fibrinogen, D-dimer concentrations) and integral assays (thromboelastography (TEG) and thrombodynamics (TD)). Platelet functional activity was estimated by flow cytometry. Single nuclear polymorphisms of coagulation system genes were studied.ResultsFibrinogen concentration and fibrinogen-dependent parameters of TEG and TD were increased in patients indicating systemic inflammation. In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation. However, in some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation. Resting platelets were characterized by glycoprotein IIb-IIIa activation and degranulation. In patients with fatal IE, we observed a significant decrease in fibrinogen and thrombodynamics. In patients with embolism, we observed a significant decrease in the TEG R parameter. No association of embolism or mortality with genetic polymorphisms was found in our cohort.ConclusionsOur findings suggest that coagulation in patients with infective endocarditis is characterized by general hypercoagulability and platelet pre-activation. Some patients, however, have hypocoagulant coagulation profile, which presumably can indicate progressing of hypercoagulation into consumption coagulopathy.

Highlights

Infectious endocarditis (IE) is an infection of the heart inner surface mainly affecting heart valves
In majority of patients clot growth rate in thrombodynamics was significantly shifted towards hypercoagulation in consistency with D-dimers elevation
In some patients prothrombin, thromboelastography and thrombodynamics were shifted towards hypocoagulation

Summary

Introduction

Infectious endocarditis (IE) is an infection of the heart inner surface mainly affecting heart valves. Vegetations are structures formed on the endocardium of heart valves or heart chambers and consisting of fibrin, platelets and bacteria. They originate from primary endocardial injury, followed by focal adherence of platelets and fibrin and secondarily infected by microorganisms circulating in the blood [5]. These structures subsequently lose rigidity and are disrupt which may result in thromboembolism of pulmonary or other major arteries. Coagulation system is heavily involved into the process of infective endocarditis (IE) vegetation formation and can facilitate further embolization. We aim to determine whether prothrombotic genetic polymorphisms play any role in embolization and mortality in IE patients

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