| Objectives To investigate the vulnerable blood in elderly male patients with coronary artery disease and to explore the useful haemostatic markers to assess the vulnerable blood, and risk factors for vulnerable blood among those old patients.Methods Total 60 aged male patients were enrolled, who were documented by coronary artery angiography, including 41 patients with coronary artery disease (stable angina pectoris in 10 and unstable angina pectoris in 31) and 19 control subjects with relatively normal angiograms. Clinical information included age, body mass index (BMI), smoking index, and the complications of primary hypertension or diabetes, and CAD family history. Venous blood was sampled serially for the determination of TC, TG, HDL, LDL, Hey, hs-CRP, Fg, D-dimer, apoAl , apoB, sTM, and markers of fibrinolytic system and hypercoagulability, such as D-dimer, free TFPI, etc. The extent of coronary atherosclerosis was assessed, using the Gensini scoring system on the basis of coronary angiography.Results Compared with the controls, the patients with coronary artery disease had significantly higher levels of sTM, f-TFPI, Hey, and D-dimer. D-dimer was significantly correlated to age, hs-CRP, Hey, PAI and f-TFPI. f-TFPI was significantly correlated to hs-CRP, smoking index, Hey, PC and D-dimer. Subjects were respectively assigned to triplicate bases on their D-dimer, hs-CRP and f-TFPI levels. The OR value for CAD in the patients with D-dimer levels in the top triplicate increased 14.54-fold compared to that of individuals with lower levels, and the OR value was 6.65 for f-TFPI in the top triplicate. The OR value for unstable angina in the patients with D-dimer levels in the top triplicate was 48-fold higher than that of patients in the lowest triplicate (OR=48, Z=3.28, P=0.001). In an ordinal logistic regression, the OR value of developing more serious CAD augmented3.1-fold each increasing triplicate of D-dimer, the OR value augmented 1.9-fold with each increasing triplicate of f-TFPI, and 3.0 fold for hs-CRP. Anova variance analysis showed D-dimer differed dramatically among the patients with UA, the patients with SA and the controls (.P=0.005). The patients with UA had a significantly higher level of D-dimer than the controls (P=0.005), and an increasing trend compared with the patients with SA (P=0.059), whereas there was no difference between the patients with SA and the controls (/"=0.885). The patients in different clinical severities had different f-TFPI levels (P=0.000) and patients with UA owned a higher f-TFPI level than the patients with SA or the controls. There was significant difference among the three groups for hs-CRP and Hey. Smoking index, fasting blood sugar, hs-CRP, PAI, f-TFPI sTM and D-dimer were all significantly correlated with Gensini scores.Conclusions There is a complicated interrelation among the endothelial damage, the inflammatory state and the procoagulant and fibrinolytic states in the elderly male patients with CAD. Compared with patients without CAD, the aged male patients with CAD have more severely vulnerable blood, especially the patients with UA. Compared with f-TFPI, D-dimer may be a more helpful marker in identifying the severity of vulnerable blood. Measurements of D-dimer may provide a cost-effective approach to screen vulnerable blood and provide reliable pathways for monitoring anticoagulant therapy. Hey may be a significant risk factor for vulnerable blood. It could be useful for patients with CAD to zealously lower the increased levels of Hey in addition to caring other traditional risk factors.
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