Abstract | BACKGROUND: METHODS: RESULTS: Plasma levels of fibrinogen, factor VIII and von Willebrand factor were significantly higher in both groups of patients than in normal controls. Fibrinolytic activity was significantly reduced in transplant patients treated with steroids, compared with steroid-free patients and normal controls. In steroid-treated heart transplant recipients, the hypofibrinolytic state was due to a significant and pathological increase in PAI-1 antigen and activity levels. The fibrinolytic impairment was more evident in patients transplanted for ischemic heart disease and treated with steroids than in patients with previous dilated cardiomyopathy and treated either with or without steroids. Myocardial microthrombi were found in 2/49 cases at the first biopsy control, and in 12/49 cases at the last biopsy control after transplantation. This different prevalence was statistically significant (chi2 = 8.33, p = .003). Plasma PAI-1 activity was significantly higher and, as a consequence, euglobulin lysis time was more prolonged in microthrombi-positive patients than in microthrombi-negative ones. Among the 12 transplant recipients who developed cardiac microthrombi, 7 patients were treated with steroids and showed higher PAI-1 levels and more reduced fibrinolytic activity than the 5 steroid-free patients. CONCLUSIONS: Our data confirm the prothrombotic state induced by long-term steroid treatment, characterized by an increase in PAI-1 levels and secondary impairment of fibrinolytic capacity. In heart transplant patients, steroid-related hypofibrinolysis might constitute a further risk factor for transplant coronary artery disease.
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Authors | T M Sartori, P G Maurizio, P Sara, L Ugolino, A Annalisa, T Panagiotis, F Massimo, G Antonio |
Journal | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
(J Heart Lung Transplant)
Vol. 18
Issue 7
Pg. 693-700
(Jul 1999)
ISSN: 1053-2498 [Print] United States |
PMID | 10452346
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Glucocorticoids
- Immunosuppressive Agents
- Cyclosporine
- Azathioprine
- Prednisone
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Topics |
- Azathioprine
(adverse effects)
- Biopsy
- Coronary Artery Disease
(blood, chemically induced, pathology)
- Cyclosporine
(adverse effects)
- Drug Therapy, Combination
- Female
- Fibrinolysis
(drug effects, physiology)
- Glucocorticoids
(adverse effects)
- Heart Diseases
(blood, chemically induced, pathology)
- Heart Transplantation
(physiology, statistics & numerical data)
- Humans
- Immunosuppressive Agents
(adverse effects)
- Male
- Middle Aged
- Myocardium
(pathology)
- Postoperative Care
(adverse effects, methods)
- Prednisone
(adverse effects)
- Thrombosis
(blood, chemically induced, pathology)
- Time Factors
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