Abstract
Background Despite long-term antiplatelet therapy with aspirin, recurrent cardiovascular events
remain common in patients with coronary artery disease (CAD).
Objective We aimed to determine whether fibrin network characteristics are predictive of vascular
events in patients with stable CAD treated with aspirin monotherapy.
Methods We included 786 patients with angiographically documented CAD and either prior myocardial
infarction, type 2 diabetes mellitus, or both. Median follow-up time was 3 years.
At inclusion, fibrin clot properties were evaluated using a turbidimetric assay and
the following clot parameters were studied: (1) maximum absorbance, a measure of clot
density and fiber thickness; (2) lysis time, assessing fibrinolysis potential; and
(3) area under the curve (AUC), a measure of clot formation and lysis. The primary
endpoint was the composite of nonfatal myocardial infarction, ischemic stroke, and
cardiovascular death. Hazard ratios (HRs) were estimated using multivariable Cox proportional
hazards regression.
Results A total of 70 primary endpoints occurred. The primary endpoint occurred more frequently
in CAD patients with increased clot AUC (crude HR for first vs. fourth quartile: 2.4
[95% confidence interval 1.2–4.6], p = 0.01). This finding remained significant after adjusting for potential confounders
(adjusted HR: 2.4 [1.2–4.8], p = 0.01). Neither clot maximum absorbance nor lysis time showed significant association
with future vascular events (adjusted HR for maximum absorbance 1.8 [0.9–3.7]; p = 0.09) and lysis time (1.6 [0.8–3.0]; p = 0.18).
Conclusion We demonstrate that increased clot AUC predicts future cardiovascular events in stable
CAD patients receiving aspirin monotherapy.
Keywords
aspirin - blood coagulation - fibrin clot - fibrinolysis - coronary artery disease
