Ihosvany Fernández-Bello1, Elena Monzón Manzano1, Francisco García Río2, Raul Justo Sanz1, Carolina Cubillos-Zapata3, Raquel Casitas3, Begoña Sánchez4, Ana Jaureguizar4, Paula Acuña1, Alberto Alonso-Fernández5, María Teresa Álvarez Román1, Víctor Jiménez Yuste6, Nora V Butta7. 1. Hematology Unit, Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046, Spain. 2. Respiratory Diseases Research Group, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain. 3. Respiratory Diseases Research Group, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain. 4. Respiratory Diseases Research Group, Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain. 5. Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain. 6. Hematology Unit, Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain. 7. Hematology Unit, Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046, Spain. Electronic address: nora.butta@salud.madrid.org.
Abstract
INTRODUCTION: Growing evidence shows a hypercoagulable state in obstructive sleep apnea (OSA) that could be a risk factor for thromboembolic disease. OBJECTIVES: We aimed to elucidate mechanisms involved in the procoagulant profile observed in patients with OSA and to investigate the potential utility of global tests in its characterization. METHODS: Thirty-eight patients with severe OSA without previous history of thrombosis and nineteen healthy age- and sex-matched controls were included. Kinetic of clot formation was determined using rotational thromboelastometry. Haemostatic capacity of plasma and microparticles was determined by Calibrated Automated Thrombinography. Platelet surface receptors, activation markers and formation of platelet/leukocytes aggregates were analyzed by flow cytometry. RESULTS: Thromboelastometry showed a procoagulant state in patients with OSA that did not seem to be related to a basal activation of platelets but by the increased existence of platelet/leukocyte aggregates. Patients with OSA presented many signs of endothelial damage such as increased plasma levels of E-selectin and cfDNA and enhanced thrombin generation due to the presence of microparticles rich in tissue-factor, which is related to OSA severity. CONCLUSIONS: OSA induces an enhancement in the dynamics of clot formation which appears to be caused by at least two pathological mechanisms. First, a greater formation of platelet-leukocyte aggregates; secondly, endothelial damage which provokes a greater procoagulant potential due to the increase in tissue factor-rich microparticles. Moreover, this study has identified thromboelastometry and thrombin generation assay as useful tools to evaluate the prothrombotic state in these patients.
INTRODUCTION: Growing evidence shows a hypercoagulable state in obstructive sleep apnea (OSA) that could be a risk factor for thromboembolic disease. OBJECTIVES: We aimed to elucidate mechanisms involved in the procoagulant profile observed in patients with OSA and to investigate the potential utility of global tests in its characterization. METHODS: Thirty-eight patients with severe OSA without previous history of thrombosis and nineteen healthy age- and sex-matched controls were included. Kinetic of clot formation was determined using rotational thromboelastometry. Haemostatic capacity of plasma and microparticles was determined by Calibrated Automated Thrombinography. Platelet surface receptors, activation markers and formation of platelet/leukocytes aggregates were analyzed by flow cytometry. RESULTS: Thromboelastometry showed a procoagulant state in patients with OSA that did not seem to be related to a basal activation of platelets but by the increased existence of platelet/leukocyte aggregates. Patients with OSA presented many signs of endothelial damage such as increased plasma levels of E-selectin and cfDNA and enhanced thrombin generation due to the presence of microparticles rich in tissue-factor, which is related to OSA severity. CONCLUSIONS: OSA induces an enhancement in the dynamics of clot formation which appears to be caused by at least two pathological mechanisms. First, a greater formation of platelet-leukocyte aggregates; secondly, endothelial damage which provokes a greater procoagulant potential due to the increase in tissue factor-rich microparticles. Moreover, this study has identified thromboelastometry and thrombin generation assay as useful tools to evaluate the prothrombotic state in these patients.
Authors: Mathew K Marsee; Faisal S Shariff; Grant Wiarda; Patrick J Watson; Ali H Sualeh; Toby J Brenner; Max L McCoy; Hamid D Al-Fadhl; Alexander J Jones; Patrick K Davis; David Zimmer; Craig Folsom Journal: J Clin Med Date: 2022-02-20 Impact factor: 4.241
Authors: Katie L J Cederberg; Umaer Hanif; Vicente Peris Sempere; Julien Hédou; Eileen B Leary; Logan D Schneider; Ling Lin; Jing Zhang; Anne M Morse; Adam Blackman; Paula K Schweitzer; Suresh Kotagal; Richard Bogan; Clete A Kushida; Yo-El S Ju; Nayia Petousi; Chris D Turnbull; Emmanuel Mignot Journal: Int J Mol Sci Date: 2022-07-20 Impact factor: 6.208