Fibrin Clot Properties and Fibrinolysis in Patients With Endocrine Hypertension Due to Aldosterone or Catecholamines Excess

Ewa Warchoł-Celińska; Aleksander Prejbisz; Piotr Dobrowolski; Ewa Wypasek; Jacek Kądziela; Sylwia Kołodziejczyk-Kruk; Marek Kabat; Anetta Undas; Andrzej Januszewicz

Disclosures

Clin Endocrinol. 2022;96(2):114-122. 

In This Article

Results

The final analysis comprised 35 patients with PA (Group 1), 32 controls with EHT (Control group 1) and 35 healthy controls (Control group 1bis) and also 16 patients with PPGL (Group 2), 22 controls with EHT (Control group 2) and 23 healthy controls (Control group 2bis). The clinical characteristics of analysed patients are presented in Table S1 (PA patients vs. controls and PPGL patients vs. controls). There were no differences in age, gender distribution, BP values and laboratory parameters between the groups; Table S1).

Baseline Haemostatic Markers and Fibrin Clot Features in PA Patients

Patients with PA as compared to the matched controls with EHT did not differ in terms of fibrin clot features, parameters of fibrinolysis or plasma thrombogenic potential (Table 1).

Both patients with PA and EHT, however, were characterized by more compact fibrin clot structure (lower Ks), impaired fibrinolysis (longer median CLT) and by faster clot formation (shorter median lag phase) as well as enhanced thrombin generation (higher ETP and thrombin peak and shorter time to thrombin peak) in comparison to healthy controls (Table 1).

Also, PA patients did not differ from EHT patients in terms of haemostatic parameters of fibrinolysis, whereas some differences that may indicate fibrinolytic disorders were observed between both those groups and healthy controls. Patients with PA and EHT were characterized by higher PAP level as compared to healthy controls. Also, higher TAFI antigen concentration in PA patients and a tendency to higher TAFI antigen concentration in EHT patients were observed. In PA patients and in EHT patients respectively tendency to higher and significantly higher F1 + 2 levels were observed as compared to healthy controls. In PA patients group, but not in EHT patients the level of t-PA antigen was significantly higher in comparison to healthy controls (Table 1).

In further analysis of the PA patient group, patients with BAH were compared to patients with APA, and no difference between patients with the two PA subtypes was observed in terms of baseline haemostatic markers and fibrin clot features (Table S2). We also found no statistically significant correlation between plasma aldosterone concentrations in PA patients and parameters assessing fibrin clot structure, plasma thrombogenic potential or haemostatic markers.

Effect of PA Treatment

Patients with PA were diagnosed with BAH (20 pts) and APA (15 pts) on the basis of the results of AVS and qualified for further treatment: pharmacological treatment with MRA—patients with BAH or adrenalectomy—patients with APA. Evaluation after 3 months of the implementation of treatment with MRA or 3 months after adrenalectomy was performed in 32 patients (18 pts with BAH and 14 pts with APA). Three patients were therefore lost to follow-up (one patient with APA finally refused to undergo adrenalectomy and two patients with BAH declined follow-up visits).

After 3 months there were no differences in haemostatic markers, fibrin clot features or plasma thrombogenic potential in treated PA patients as compared to baseline evaluation (Table 2).

In the further analysis, we evaluated fibrin clot properties separately in 14 patients with APA (13 patients with complete and 1 patient with partial biochemical success; 8 patients with complete and 6 patients with partial clinical success according to the PASO criteria 3 months after surgery and in 18 patients with BAH 3 months after implementation of MRA treatment.[15] No significant changes in haemostatic markers, fibrin clot features and plasma thrombogenic potential were found in APA and BAH patients analysed separately (Table S3).

Baseline Haemostatic Markers and Fibrin Clot Features in Patients With PPGL

No differences in clot structure and assessed haemostatic markers between PPGL and EHT patients were observed (Table 1).

Both patients with PPGL and EHT, however, were characterized by more compact fibrin clot structure (lower Ks), faster clot formation (shorter median lag phase), higher PAP level and enhanced thrombin generation (higher ETP and thrombin peak and shorter time to thrombin peak) in comparison to healthy controls (Table 1). Patients with EHT were also characterized by longer median CLT as compared to healthy controls, whereas in PPGL patients the same tendency did not reach statistical significance (p = .08; Table 1).

In the further analysis, we investigated the PPGL group founding no correlations between plasma normetanephrine and metanephrine levels with clot properties, plasma thrombogenic potential or assessed haemostatic markers.

Effect of Surgery in Patients With PPGL

All 16 patients with PPGL had pheochromocytoma and underwent adrenalectomy. Fifteen patients were re-evaluated 3 months after surgery. One patient was lost to follow-up (patient failed to attend the follow-up visit despite several attempts to schedule it). After 3 months there were no changes in haemostatic markers, fibrin clot features or plasma thrombogenic potential in patients who underwent adrenalectomy due to PPGL as compared to baseline (Table 2).

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