Skip to main content
main-content

01.12.2014 | Original Article | Ausgabe 6/2014

Virchows Archiv 6/2014

Total burden of intraplaque hemorrhage in coronary arteries relates to the use of coumarin-type anticoagulants but not platelet aggregation inhibitors

Zeitschrift:
Virchows Archiv > Ausgabe 6/2014
Autoren:
Xiaofei Li, Aryan Vink, Hans W. M. Niessen, Jesper Kers, Onno J. de Boer, Hanneke J. P. Ploegmakers, Jan G. P. Tijssen, Robbert J. de Winter, Allard C. van der Wal

Abstract

Intraplaque hemorrhage (IPH) is a crucial factor in progression and destabilization of an atherosclerotic plaque. Anti-thromboembolic drugs are widely used as prophylactic treatment against arterial and venous thrombotic diseases, but a major complication is bleeding. We investigated the association between exposure to anti-thromboembolic therapy and IPH in postmortem coronary arteries. Coronary arteries with postmortem angiographically confirmed extensive atherosclerosis were obtained at autopsy from patients who had received oral anticoagulants (n = 10), platelet aggregation inhibitors (n = 10), or no anti-thrombotic drugs (n = 10) before death. Coronary arteries were cut at 3-mm interval, and all plaque-containing segments were immunohistochemically screened for IPH and microvessels. These data were related to overall plaque composition and the use of anti-thromboembolic therapies. IPH was found in 483 out of 904 (53 %) coronary segments with advanced atherosclerotic plaques and more frequently in patients on oral anticoagulants (174/284, 61 %) than in patients on anti-platelets (198/376, 53 %) or without therapy (111/244, 46 %) (P = 0.02 and P = 0.001, respectively). Also, intraplaque microvascular leakage was more frequently observed in patients on anticoagulants than in non-treated patients (P = 0.03). Finally, the IPH appeared to be larger in plaques of patients on anticoagulant treatment (P < 0.001). Density of intraplaque microvessels was highest in plaques of patients on platelet inhibitors (P < 0.05), but this was not associated with increased hemorrhagic burden. Prophylactic therapy with oral coumarin-type anticoagulants appears to be associated with a higher hemorrhagic burden in atherosclerotic coronary arteries, which may lead to increase in plaque volume over time, in this selected subgroup of patients.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 6/2014

Virchows Archiv 6/2014 Zur Ausgabe

Neu im Fachgebiet Pathologie

27.11.2018 | Hauptreferate: Tumorevolution II | Sonderheft 2/2018

Zirkulierende Tumorzellen beim Pankreaskarzinom

Ergebnisse morphologischer und molekularer Analysen und Vergleiche mit dem Primärtumor

23.11.2018 | Hauptreferate: Hauptprogramm der DGP | Sonderheft 2/2018

Das Urachuskarzinom – aktuelle Konzepte einer seltenen Tumorerkrankung

16.11.2018 | Hauptreferate: Hauptprogramm der DGP | Sonderheft 2/2018

Das Deutsche Mesotheliomregister

Aktuelle pathologische Diagnostik und Leistungen

14.11.2018 | Originalien | Ausgabe 6/2018

Retinale Blutungen beim Schütteltrauma

Differenzialdiagnostische Aspekte