Evaluation of haemostatic mechanisms in the elderly

ABSTRACT

Aging is associated with changes in the haemostatic balance including coagulation, flbrinolytic and/or platelet activity. Adverse changes in coagulation and flbrinolytic factors are thought to contribute to the increased risk of cardio-vascular disease and atherothrombosis with age. In this study the aim was to determine how the biological factor of age affected coagulation, flbrinolytic factors and platelet glycoprotein receptors levels. In so doing the effect of age on the two important systems in the body involved in haemostasis namely, the coagulation and flbrinolytic systems was studied. The population studied consisted of ten young healthy controls aged 20 - 30 years representing [group I], twenty subjects aged 60 - 70 years [group II], twenty subjects aged 70 - 80 years [group III] and ten subjects above 80 years [group IV]. All groups were subjected to thorough history taking, complete clinical examination and routine investigations excluding obeses, hypertensives, diabetics, patients with chronic obstructive pulmonary disease [COPD] or ischemic heart disease and patients with peripheral vascular disease. Investigations of coagulation parameters [procoagulant markers] included prothrombin activity, estimation of flbrinogen level, Factor VII assay, Thrombin antithrombin [TAT] complex, Prothrombin fragment 1+2 [PF1+2]. Investigations of flbrinolytic system [flbrinolytic markers] included Tissue plasminogen activator [TPA] and tissue plasminogen activator- inhibitor [TPA-I], Flow cytometric investigation of platelet receptors, including platelet membrane glycoprotein GPIIb, Ilia, and GPIb. Prothrombin activity and TAT complex were found to increase with age but their differences between the aged groups and group I did not attain a statistical significance. Serum flbrinogen, factor VII and PF 1+2 were rising with the advancement of age and their means were significantly higher in all aged group in comparison with the young group.Serum TPA and TPA-I showed a progressive increase with age and their means were significantly higher in all aged group in comparison to the young group. Platelet glycoprotein receptors IIb, IIIa and Ib levels were found statistically significant higher in all aged groups in relation to group I. The maximum increase was found in group IV. The age-dependency of these markers has to be taken into account in respect to their clinical use in order to characterize patients with suspected risk of atherosclerotic events. In future, one should consider routinely screening for these markers in those above the age of 60 years and, if found to be high consider giving flbrinolytic and antithrombotic agents prophylactically