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Blood coagulation and fibrinolysis in patients with Cushing's syndrome: increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels.
J Endocrinol Invest. 2009 Feb; 32(2):169-74.JE

Abstract

BACKGROUND AND OBJECTIVES

Cushing's syndrome (CS) is associated with an increased cardiovascular mortality and morbidity. Chronic endogenous and exogenous hypercortisolism frequently induce a hypercoagulable and thrombotic condition. Little is known about hemostatic features of patients with CS. To our knowledge, plasma tissue factor pathway inhibitor (TFPI) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels in these patients have not been investigated. Therefore, the main purpose of this study was to evaluate the markers of endogenous coagulation/fibrinolysis, including TFPI and TAFI, and to investigate the relationships between cortisol and these hemostatic parameters and serum lipid profile in patients with CS.

DESIGN AND METHODS

Twenty-four patients with CS and 24 age-matched healthy controls were included in the study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, factors V, VII, VIII, IX, and X activities, von Willebrand factor (vWF), antithrombin III (AT III), protein C, protein S, tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor-1 (PAI-1), TFPI and TAFI, as well as common lipid variables, were measured. The relationships between serum cortisol and these hemostatic parameters were examined.

RESULTS

Compared with the control subjects, platelet count, PT, fibrinogen, AT-III and PAI-1 were significantly increased in patients with CS (p<0.05, p<0.0001, p<0.01, p<0.05, and p<0.0001, respectively), whereas aPTT and TFPI levels were significantly decreased (p<0.0001 and p<0.01, respectively). Plasma TAFI Ag levels did not significantly change in patients with CS compared with the controls. In patients with CS, we showed a negative correlation between serum cortisol: 08:00 h and aPTT (r:-0.469, p<0.05). Serum cortisol: 24:00 h was positively correlated with PAI-1 Ag levels (r: 0.479, p<0.05).

INTERPRETATION AND CONCLUSIONS

In conclusion, we found some important differences in the hemostatic parameters between the patients with CS and healthy controls. Increased platelet count, fibrinogen, PAI-1, and decreased TFPI levels in these patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess of mortality due to cardiovascular disease seen in patients with CS.

Authors+Show Affiliations

Karadeniz Technical University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Trabzon, Turkey. cihangirerem@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19411818

Citation

Erem, C, et al. "Blood Coagulation and Fibrinolysis in Patients With Cushing's Syndrome: Increased Plasminogen Activator Inhibitor-1, Decreased Tissue Factor Pathway Inhibitor, and Unchanged Thrombin-activatable Fibrinolysis Inhibitor Levels." Journal of Endocrinological Investigation, vol. 32, no. 2, 2009, pp. 169-74.
Erem C, Nuhoglu I, Yilmaz M, et al. Blood coagulation and fibrinolysis in patients with Cushing's syndrome: increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels. J Endocrinol Invest. 2009;32(2):169-74.
Erem, C., Nuhoglu, I., Yilmaz, M., Kocak, M., Demirel, A., Ucuncu, O., & Onder Ersoz, H. (2009). Blood coagulation and fibrinolysis in patients with Cushing's syndrome: increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels. Journal of Endocrinological Investigation, 32(2), 169-74.
Erem C, et al. Blood Coagulation and Fibrinolysis in Patients With Cushing's Syndrome: Increased Plasminogen Activator Inhibitor-1, Decreased Tissue Factor Pathway Inhibitor, and Unchanged Thrombin-activatable Fibrinolysis Inhibitor Levels. J Endocrinol Invest. 2009;32(2):169-74. PubMed PMID: 19411818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood coagulation and fibrinolysis in patients with Cushing's syndrome: increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels. AU - Erem,C, AU - Nuhoglu,I, AU - Yilmaz,M, AU - Kocak,M, AU - Demirel,A, AU - Ucuncu,O, AU - Onder Ersoz,H, PY - 2009/5/5/entrez PY - 2009/5/5/pubmed PY - 2009/7/8/medline SP - 169 EP - 74 JF - Journal of endocrinological investigation JO - J Endocrinol Invest VL - 32 IS - 2 N2 - BACKGROUND AND OBJECTIVES: Cushing's syndrome (CS) is associated with an increased cardiovascular mortality and morbidity. Chronic endogenous and exogenous hypercortisolism frequently induce a hypercoagulable and thrombotic condition. Little is known about hemostatic features of patients with CS. To our knowledge, plasma tissue factor pathway inhibitor (TFPI) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels in these patients have not been investigated. Therefore, the main purpose of this study was to evaluate the markers of endogenous coagulation/fibrinolysis, including TFPI and TAFI, and to investigate the relationships between cortisol and these hemostatic parameters and serum lipid profile in patients with CS. DESIGN AND METHODS: Twenty-four patients with CS and 24 age-matched healthy controls were included in the study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, factors V, VII, VIII, IX, and X activities, von Willebrand factor (vWF), antithrombin III (AT III), protein C, protein S, tissue plasminogen activator (t-PA), tissue plasminogen activator inhibitor-1 (PAI-1), TFPI and TAFI, as well as common lipid variables, were measured. The relationships between serum cortisol and these hemostatic parameters were examined. RESULTS: Compared with the control subjects, platelet count, PT, fibrinogen, AT-III and PAI-1 were significantly increased in patients with CS (p<0.05, p<0.0001, p<0.01, p<0.05, and p<0.0001, respectively), whereas aPTT and TFPI levels were significantly decreased (p<0.0001 and p<0.01, respectively). Plasma TAFI Ag levels did not significantly change in patients with CS compared with the controls. In patients with CS, we showed a negative correlation between serum cortisol: 08:00 h and aPTT (r:-0.469, p<0.05). Serum cortisol: 24:00 h was positively correlated with PAI-1 Ag levels (r: 0.479, p<0.05). INTERPRETATION AND CONCLUSIONS: In conclusion, we found some important differences in the hemostatic parameters between the patients with CS and healthy controls. Increased platelet count, fibrinogen, PAI-1, and decreased TFPI levels in these patients represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. This condition may contribute to the excess of mortality due to cardiovascular disease seen in patients with CS. SN - 1720-8386 UR - https://www.unboundmedicine.com/medline/citation/19411818/Blood_coagulation_and_fibrinolysis_in_patients_with_Cushing's_syndrome:_increased_plasminogen_activator_inhibitor_1_decreased_tissue_factor_pathway_inhibitor_and_unchanged_thrombin_activatable_fibrinolysis_inhibitor_levels_ L2 - https://link.springer.com/article/10.1007/BF03345709 DB - PRIME DP - Unbound Medicine ER -