SHAPE Society

1. Editorial Slides
VP Watch, March 05, 2003, Volume 3, Issue 9
Vulnerable (Thrombogenic) Blood;
A New Step Towards The Definition Of Vulnerable Patients
Morteza Naghavi, MD

2. –Pathology studies have
consistently shown that plaque
rupture are often not accompanied
by luminal occlusive thrombi.
–Silent plaque rupture is a well
supported observation.

3. –The questions are in what
circumstances plaque ruptures go silent
and remain undetected. What are the
other additional factors that play a role
in the clinical outcome of
atherosclerosis besides plaque
rupture?
–Though the reasons for this are
unknown, it seems clear that blood
thrombogenicity plays a significant role
in the outcome of plaque rupture or

4. –One putative link between the plaque
complication and the ensuing
thrombosis is the circulating tissue
factor (TF)1,2
that has been shown to be
present in platelets in the setting of
thrombi.3
–Therefore, it is not surprising that TF is
increased in plasma of patients with
acute coronary syndromes, compared
to patients with stable angina.4

5. –As featured in VPWatch of this
week, Sambola, Badimon and
colleagues5
studied the tissue
factor levels and blood
thrombogenicity in the Badimon
perfusion chamber of poorly-
controlled patients with Type 2
diabetes, smokers and untreated
hyperlipidemic patients.

6. Control
Circulating Tissue Factor Activity is Statistically Increased inCirculating Tissue Factor Activity is Statistically Increased in
Smokers and Patients with HyperlipidemiaSmokers and Patients with Hyperlipidemia

7. In patients with diabetes, the TF activity decreased with
improvement of glycemia status. Blood thrombogenicity decreased
in agreement with lower TF.

8. • This study correlates
increased levels of circulating
tissue factor activity
associated with diabetes
mellitus, hyperlipidemia, and
smoking.
Conclusion:

9. • These data indicate that the
previously reported hyperthrombotic
state responsible for the increased
rate of atherothrombotic
complications among diabetic,
hyperlipemic, and smoker
populations could be mediated via
increased levels of circulating TF.
Conclusion:

10. • The authors concluded:
- 1) Increased blood thrombogenecity in poorly
controlled T2DM seems to be related to
plasma levels of a circulating pool of
activatable TF activity.
- 2) Improvements in glycemic control are
associated with a reduction in plasma levels of
circulating TF activity and BT.
- 3) Risk factors such as hyperlipidemia and
smoking have a significant modulatory effect
on plasma levels of circulating TF and BT.
Conclusion:

11. • Increased thrombogenesity of
circulating blood is the most
important factor for development of
coronary thrombosis?
– Agree
– Disagree
– Data not available
Questions:

12. • Decreased endogenous fibrinolytic
activity of blood is the most
important factor in coronary
thrombosis
– Agree
– Disagree
– Data not available
Questions:

13. • Thrombogenic lipid core in a
vulnerable plaque is the most
important factor in coronary
thrombosis.
– Agree
– Disagree
– Data not available
Questions:

14. • Silent plaque rupture is mainly due
to having non-thrombogenic blood.
– Agree
– Disagree
– Data not available
Questions:

15. • Silent plaque rupture is mainly due
to having an active fibrinolytic
system.
– Agree
– Disagree
– Data not available
Questions:

16. • Silent plaque rupture is mainly due
to having a non-thrombogenic lipid
core.
– Agree
– Disagree
– Data not available
Questions: