Thromb Haemost 1992; 68(05): 516-520
DOI: 10.1055/s-0038-1646310
Original Article
Schattauer GmbH Stuttgart

Fibrinolytic Potential and Antiphospholipid Antibodies in Systemic Lupus Erythematosus and Other Connective Tissue Disorders

M Jurado
1   The Hematology Services, Hospital Virgen de las Nieves, Granada, Spain
,
J A Páramo
2   The Hematology Services, University Clinic of Navarra, Pamplona, Spain
,
M Gutierrez-Pimentel
1   The Hematology Services, Hospital Virgen de las Nieves, Granada, Spain
,
E Rocha
2   The Hematology Services, University Clinic of Navarra, Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Received 15 November 1991

Accepted after revision 22 June 1992

Publication Date:
04 July 2018 (online)

Summary

We studied the fibrinolytic response before and after venous occlusion (VO) in 30 patients with systemic lupus erythematosus (SLE), 25 with rheumatoid arthritis (RA) and 25 with different connective tissue disorders. Results were compared in patients with and without antiphospholipid antibodies (APA) and a history of either thrombosis or abortions. Before occlusion plasma levels of tissue-type plasminogen activator (t-PA) antigen and its inhibitor (PAI-1) were significantly higher in the patient group (p <0.001). After occlusion, a low fibrinolytic activity on fibrin plates (p <0.005) was observed in the same group. t-PA capacity and t-PA release were similar in relation to controls. The plasma PAI-1 activity was significantly elevated in each group of patients (p <0.005) as compared to the control group. No significant differences with respect to t-PA and PAI-1 were observed in patients as to the presence or absence of thrombosis. There was also no correlation between the fibrinolytic changes and the presence of APA. It is concluded that an impairment of the fibrinolytic system, mainly related to increased PAI-1 levels, is present in most patients with connective tissue disorders, although these changes did not correlate with the presence of APA or the incidence of thrombosis.

 
  • REFERENCES

  • 1 Harris EN, Hughes GRV, Gharavi AE. Anti-cardiolipin antibodies and the lupus anticoagulant. Clin Exp Rheumatol 1986; 4: 187-190
  • 2 Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 1990; 112: 682-698
  • 3 Carreras LO, Defreyn G, Machin SJ. et al Arterial thrombosis, intrauterine death and “lupus” anticoagulant: detection of immunoglobulin interfering with prostacyclin formation. Lancet 1981; 1: 244-246
  • 4 Cosgriff TM, Martin BA. Low functional and high antigenic anti-thrombin III level in a patient with the lupus anticoagulant and recurrent thrombosis. Arthritis Rheum 1981; 24: 94-96
  • 5 Freyssinet JM, Wiesel ML, Gauchy J, Boneu B, Cazenave JP. An IgM lupus anticoagulant that neutralizes the enhancing effect of phospholipid on purified endothelial thrombomodulin activity - a mechanism for thrombosis. Thromb Haemostas 1986; 55: 309-313
  • 6 Amer L, Kisiel W, Searles RP, Williams RC. Impairment of the protein C anticoagulant pathway in a patient with systemic lupus erythematosus, anticardiolipin antibodies and thrombosis. Thromb Res 1990; 57: 247-258
  • 7 Angles Cano, Sultan Y, Clauvel JP. Predisposing factors to thrombosis in systemic lupus erythematosus: possible relation to endothelial cell damage. J Lab Clin Med 1979; 94: 312-323
  • 8 Glas-Greenwalt P, Kant KS, Allen C, Pollack VE. Fibrinolysis in health and disease: severe abnormalities in systemic lupus erythematosus. J Lab Clin Med 1984; 104: 962-976
  • 9 Francis RB, McGehee WG, Feinstein DI. Endothelial-dependent fibrinolysis in subjects with the lupus anticoagulant and thrombosis. Thromb Haemostas 1988; 59: 412-414
  • 10 Violi F, Ferro D, Valesini G. et al Tissue plasminogen activator inhibitor in patients with systemic lupus erythematosus and thrombosis. Br Med J 1990; 300: 1099-1102
  • 11 Páramo JA, Alfaro MJ, Rocha E. Postoperative changes in the plasmatic levels of tissue-type plasminogen activator and its fast-acting inhibitor. Relationship to deep vein thrombosis and influence of prophylaxis. Thromb Haemostas 1985; 54: 713-716
  • 12 Páramo JA, Colucci M, Collen D, Van de Werf F. Plasminogen activator inhibitor in the blood of patients with coronary artery disease. Br Med J 1985; 291: 573-574
  • 13 Exner T, Rickard KA, Kronenberg H. A sensitive test demonstrating lupus anticoagulant and its behavioral patterns. Br J Haematol 1978; 40: 141-143
  • 14 Thiagarajan P, Pengo V, Shapiro SS. The use of the dilute Russell viper venom time for the diagnosis of lupus anticoagulants. Blood 1986; 68: 869-874
  • 15 Schleider MA, Nachman RL, Jaffe EA, Coleman M. A clinical study of the lupus anticoagulants. Blood 1976; 48: 499-509
  • 16 Loizou S, McCrea JD, Rudge AC, Reynolds R, Boyle CC, Harris EN. Measurement of anti-cardiolipin antibodies by an enzyme linked immunosorbent assay (ELISA): standardization and quantitation of results. Clin Exp Immunol 1985; 62: 738-745
  • 17 Astrup T, Mullertz S. Fibrin plate method for estimating fibrinolytic activity. Arch Biochem Biophys 1952; 40: 346-351
  • 18 Hamsten A, Wiman B, De Faire V, Blomback M. Increased plasma levels of a rapid inhibitor of tissue plasminogen activator in young survivors of myocardial infarction. N Engl J Med 1985; 313: 1557-1563
  • 19 Harris EN, Gharavi AE, Hughes GRV. Antiphospholipid antibodies. Clin Rheum Dis 1985; 11: 591-609
  • 20 Khamashta MA, Harris EN, Gharavi AE. et al Immune mediated mechanism for thrombosis: antiphospholipid antibody binding to platelet membranes. Ann Rheum Dis 1988; 47: 849-854
  • 21 Kienast J, Bohm H, Ostermann H, Van de Loo J. Antiphospholipid antibodies in patients prone to thrombosis: prevalence, specificity, and relation to impaired fibrinolysis. Thromb Haemostas 1989; 62: 374 (Abstr)
  • 22 Awada H, Barlowatz-Meimon G, Dougados M, Maisonneuve P, Sultan Y, Amor B. Fibrinolysis abnormalities in systemic lupus erythematosus and their relation to vasculitis. J Lab Clin Med 1988; 111: 229-236
  • 23 Ruiz-Arguelles GJ, Ruiz-Arguelles A, Lobato-Mendizábal E. et al Disturbances in the tissue plasminogen activator/Plasminogen activator inhibitor (tPA/PAI) system in systemic lupus erythematosus. Am J Hematol 1991; 37: 09-13
  • 24 Keeling DM, Campbell SJ, Mackie IJ, Machin SJ, Isenberg DA. The fibrinolytic response to venous occlusion and the natural anticoagulants in patients with antiphospholipid antibodies both with and without systemic lupus erythematosus. Br J Haematol 1991; 77: 354-359
  • 25 Le Roux G, Guillevin L, Casassus P, Gayraud M, Limon S. Maladie de Behçet: étude fonctionelle vasculaire par le test de stase veineuse et la perfusion de DDAVP. Rev Med Intern 1985; 6: 111-115
  • 26 Hampton KK, Chamberlain MA, Menon DK, Davies JA. Coagulation and fibrinolytic activity in Behçet's disease. Thromb Haemostas 1991; 66: 292-294
  • 27 Belch JJ, McArdle B, Madhok R. et al Decreased plasma fibrinolysis in patients with rheumatoid arthritis. Ann Rheum Dis 1984; 43: 774-777
  • 28 Byron MA, Allington MJ, Chapel HM, Mowat AG, Cederholm-Williams SA. Indications of vascular endothelial cell dysfunction in systemic lupus erythematosus. Ann Rheum Dis 1987; 46: 741-745
  • 29 Angles-Cano E. Endothelial damage and hypofibrinolysis in systemic lupus erythematosus. Thromb Haemostas 1989; 61: 322
  • 30 Belch JJ, Zoma A, McLaughlin K. Fibrinolysis in systemic lupus erythematosus: effect of deamino D-arginine vasopressin infusion. Br J Rheumatol 1987; 26: 262-266
  • 31 Tsakiris DA, Marbet GA, Makris PE, Settas L, Duckert F. Impaired fibrinolysis as an essential contribution to thrombosis in patients with lupus anticoagulant. Thromb Haemostas 1989; 61: 175-177
  • 32 Nilsson TK, Lofvenberg E. Decreased fibrinolytic capacity and increased von Willebrand factor levels as indicators of endothelial cell dysfunction in patients with lupus anticoagulant. Clin Rheumatol 1989; 8: 58-63
  • 33 Nilsson IM, Ljunger H, Tengborn L. Two different mechanisms in patients with venous thrombosis and defective fibrinolysis: low concentration of plasminogen activator or increased concentration of plasminogen activator inhibitor. Br Med J 1985; 290: 1453-1456
  • 34 Nguyen G, Horellou MH, Kruithof EKO, Conard J, Samama MM. Residual plasminogen activator inhibitor activity after venous stasis as a criterion for hypofibrinolysis: A study in 83 patients with confirmed deep vein thrombosis. Blood 1988; 72: 601-605