Coagulation, fibrinolysis and platelet P-selectin expression in peripheral vascular disease.

Abstract

to examine coagulation, fibrinolysis, and platelet activity in patients with peripheral vascular disease (PVD). fifty consecutive PVD patients and 50 healthy volunteers. (Prospective comparative study.) P-selectin expression in non-fixed, whole blood was measured flow cytometrically on non-stimulated and ADP- and TRAP-6-stimulated samples. Plasma fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 were determined using standard techniques. Disease severity was stratified on the basis of the ankle-brachial pressure index (ABPI) and the angiographic data were assessed using the Bollinger score. coagulation and fibrinolysis parameters as well as the P-selectin expression on both stimulated and non-stimulated platelets were significantly increased in patients vs controls (all p<0.01). The respective sensitivity and specificity were as follows: P-selectin expression (81%, 94%), vWF (72%, 86%), fibrinogen (64%, 98%), PAI-1 (44%, 90%), tPA (15%, 100%). P-selectin expression on TRAP-6-stimulated MP correlated with disease severity (r=0.40, p<0.01). these findings support the concept of ongoing thrombogenesis in the subclinical progression of PVD and demonstrate the high diagnostic sensitivity of flow cytometric analysis of platelet activation.