February 2019: Coagulation and Your Heart

by Donna Castellone, MS, MT (ASCP) SH • February 07, 2019




Since February is dedicated to matters of the heart, I thought a good topic would look at coagulation factors and how they impact heart health.

Heart failure is a heterogeneous condition and can be caused by systolic or diastolic dysfunction resulting in impaired blood flow contributing to both arterial and venous thrombosis. It is a leading cause of morbidity and mortality and contributes to stroke and atrial fibrillation (AF). Markers can be useful in predicting chronic heart failure. Coagulation has played a role in ischemic heart disease, but which factors contribute to this is still a topic for investigation.

Several studies have looked at the impact of acute phase reactive proteins and the association with their risk of coronary heart disease (CHD). A study looked at the effect of the inflammatory markers including C-reactive protein (CRP) and interleukin-6 (IL-6) on CHD risk by examining 247 cases with 473 matched controls. Fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator antigen (t-PA), and D-dimer were associated with increased CRP and IL 6 levels as well as the risk for CHD. The most significant association was the d-dimer and IL-6 which had the highest odds ratio of 3.10 and 2.79 respectively adding to the potential to increase the prediction of CHD.1

Another prospective study looked at some additional coagulation proteins including Factor VII, VIII, IX, aPTT, activated protein C and NT-proBNP. NT-proBNP is a marker of neurohormonal activation and ventricular wall stress. The study included 3366 men between the ages of 60-79 who had no incidence of heart failure, VTE, and were not on warfarin for 13 years. There were 203 cased of heart failure. Results showed that d-dimer and vWF were significantly and positively associated with NT-proBNP. This suggests that increased coagulation activity is related to cardiac stress as well as when occurring in heart failure, it may be related to neurohormonal activation.2

What about the influence of stress and your heart? It has been shown that even in healthy people that acute mental stress can activate coagulation and fibrinolytic systems. When you have a person who also has atherosclerosis and place them in a stressful situation, hypercoagulability with a reduced fibrinolytic capacity may occur. Stress causes increase in several hormones including noradrenaline, renin, angiotensin II, aldosterone, and vasopressin. This in turn causes an increase in coagulation factors, platelet activity and cytokines.3

 

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Individual Factor Information and relation to heart disease and thrombosis:
Factor I (fibrinogen):

      • High levels associated with increased risk for myocardial infarction and arterial thrombosis
      • Insufficient clinical data to demonstrate that lowering fibrinogen will prevent ischemic heart disease

Factor II (prothrombin):

      • High levels associated with increased risk of venous thrombosis

Factor V:

      • High levels associated with increased risk of arterial thrombosis
      • There are no studies showing that reduction of factor V activity will reduce risk for ischemic heart disease or stroke

Factor VII:

      • High levels or certain genetic polymorphisms are associated with increased risk for myocardial infarction, but not an independent risk factor
      • Levels are associated with triglyceride and cholesterol levels

Factor VIII:

      • High levels associated with increased risk of venous thrombosis and arterial thrombosis
      • However normal range varies about 3-fold, levels vary with ABO blood type (15% lower with type 0) and is acute phase reactant
      • If no acute stress reaction, no aerobic exercise in past 24 hours, no estrogenic effects, then baseline value > 150% is a risk factor

Factor IX:

      • High levels associated with increased risk of venous thrombosis

Factor XI:

      • High levels (> 121%) associated with increased risk of venous thrombosis

von Willebrand factor:

      • High levels associated with increased risk of arterial thrombosis
      • No studies show that reduction of vWF levels reduces risk of ischemic heart disease, stroke or peripheral arterial disease

        Parsons J. Elevated coagulation factor levels in plasma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/coagulationelevatedcoagfactors.html.

 

Heart failure promotes a hypercoagulable state that can induce stroke, embolism and death. Causes include elevated levels of pro-thrombotic and pro-inflammatory cytokines as well as blood stasis seen in AF and left ventricular wall motion abnormalities resulting in thromboemboli. Anticoagulation therapy is used to prevent these events. The NOACs have been shown to have equivalent efficacy as warfarin in reducing strokes but with a decreased risk of bleeding. As a result, these drugs are routinely used in patients with AF.4

There is a correlation between heart failure and coagulation factors, despite different studies finding variations among what factors are increased. But take heart! It has been shown that red wine contains resveratrol that contains antioxidants which can decrease inflammation and improve vascular health in particular if it is paired with a Mediterranean diet. Now, chocolate contains flavanols which is also an antioxidant and studies have shown that dark chocolate reduces blood pressure and improves vascular health. Chocolate should be 70-80% cocoa with no added sugar and, of course, the key is moderation.

Coagulation and heart health are linked, but reducing stress, keeping those acute phase reactants at bay, a glass of wine, some chocolate and a hug all can help in keeping your heart healthy and happy!

 

 

  1. Woodward MRumley AWelsh PMacMahon SLowe G. A comparison of the associations between seven hemostatic or inflammatory variables and coronary heart disease.  J Thromb Haemost. 2007 Sep;5(9):1795-800.
  2. Wannamethee SGWhincup PHPapacosta OLennon L Lowe GD , Associations between blood coagulation markers, NT-proBNP and risk of incident heart failure in older men: The British Regional Heart Study. Int J Cardiol. 2017 Mar 1;230:567-571
  3. Mongirdiene A1, Kursvietiene LKasauskas A., The coagulation system changes in patients with chronic heart failure. Medicina (Kaunas). 2010;46(9):642-7.
  4. Thomas IEncisoSilva JSchlueter MGreenberg B, Anticoagulation Therapy and NOACs in Heart Failure. Handb Exp Pharmacol. 2017;243:515-535.