role of hypercoagulability in myocardial infarction

ABSTRACT

This study attempted to evaluate the role of haemostatic imbalances as a risk factor in the genesis of coronary thrombosis in patients with patent or insignificant coronary vessel disease and minimal standard risk factors. The study concentrated on correlating the deficiency of the major natural inhibitor of coagulation-antithrombin-III [AT-III], and other haemostatic parameters with the status of the coronary vessels and the development of ML. A total of 90 individuals [60 with myocardial infarction, 30 healthy controls] were segregated into two groups on the basis of age. Thirty patients were below 40 years of age out of whom 8 [26.7%] were found to be AT-III deficient. On angiography, 3 [10%] of them were found to be have radiologically normal coronaries, while 5 [16.7%] fell in the category of insignificant or at the most single vessel disease, with less than 40% occlusion. On screening for standard risk factors, all 8 by conventional yardsticks were considered to be at no risk of developing MI. The findings of substantive deficiency of AT-III in such patients as compared to healthy controls, p value <0.0001, with significant shortening of APTT, TT, and insignificant increase in fibrinogen concentration and platelet counts, highlight the fact that the essential mediator of thrombosis, the haemostatic imbalances, are perhaps being under-estimated. The study helped to identify prothrombotic individuals and suggests that ongoing trials with antithrombotic therapy might prove to be more rewarding if instituted prophylactically