Measurement of blood activation markers applied to the early diagnosis of cardiovascular alterations.

Introduction: This review concerns biomarkers of blood activation and their measurement in plasma, as described in the literature up to 2019, and from our personal experience. How their measurement can be informative and useful, for research studies or for diagnostic applications, is presented and discussed.Areas covered: Biochemistry and regulation of blood clotting cascade were elucidated these past decades. Understanding the various molecular mechanisms which initiate, amplify, and propagate coagulation has allowed measuring biomarkers as early indicators of hemostasis activation. They present a high usefulness for detecting hemostasis and fibrinolysis abnormalities in the clinically silent period. Sophisticated technologies are necessary for their measurement, as biomarkers are present at very low concentrations (from <1.0 ng/ml to >1.0 µg/ml).Expert opinion: Many analytes provide useful information for pathological evolution and disease severity, but only DDimer has entered routine applications. Limitations of biomarkers concern their short half-lives, their low plasma concentration, and their rapid variations. DDimer escapes these limitations and has become the biomarker of choice for ruling out DVT and PE and has increasing applications for adjusting anticoagulation or predicting diseases. Promising emerging biomarkers concern cell releasable proteins, extracellular vesicles, activated blood cells and cell aggregates, pathological metabolites, and degradation products.