Prothrombotic state

Patients with metabolic syndrome are twice as likely to develop type 2 diabetes and four times more likely to develop CHD.3,11 These individuals are usually insulin resistant, obese, have hypertension, are in a prothrombotic state, and have atherogenic dyslipidemia characterized by low HDL cholesterol and elevated triglycerides, and an increased proportion of their LDL particles are small and dense.3... 

Prothrombotic state A state of high coagulation of the blood. 

The coxibs continue to be investigated to determine whether their effect on prostacyclin production could lead to a prothrombotic state. The frequency of other adverse effects approximates that of other NSAIDs. Celecoxib causes no more edema or renal effects than other members of the NSAID group, but edema and hypertension have been documented. 

ACS represents a prothrombotic state not just confined to the culprit lesion, with evidence of a pan coronary process and generalized platelet activation. Multiple vulnerable plaques in nonculprit vessels have been identified by angioscopy or intravascular ultrasound in ACS. Protracted treatment with clopidogrel induces antiplatelet activity that provides early benefits, and may limit thrombotic events within the following months. In the CURE study, the curves of major vascular events continue to diverge and showed an additional benefit from one-month follow-up to one year. 

Following activation by the contact factor or TF pathways, the coagulation cascade is maintained in a prothrombotic state by the continued activation of factors VIII and IX to form the tenase complex, until it is down-regulated by the anticoagulant pathways (see Section 11.9). 

A report has raised the possibility that patients vvith a known prothrombotic state and raised platelet thromboxane A2 production may be at high risk of thrombosis when selective COX-2 inhibitors are used (4). 

COX-2 inhibitors inhibit the synthesis of prostacyclin in the vascular wall but not platelet thromboxane production. They could therefore theoretically increase the risk of cardiovascular events by shifting the hemostatic balance toward a prothrombotic state. However, it is not clear that theory has much impact on reality. 

The shift in hemostatic balance toward a prothrombotic state might not be the only mechanism by which COX-2 inhibitors could increase the risk of cardiovascular adverse effects. In fact, non-selective NSAIDs can raise blood pressure and antagonize the hypotensive effect of antihypertensive medications to an extent that may increase hypertension-related morbidity (55,56). The problem is clinically relevant, as arthritis and hypertension are common co-morbid conditions in elderly people, requiring concurrent therapy. 

Patients with the metabolic syndrome may have three or more of the following abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance with or without glucose intolerance, prothrombotic state, or proinflammatory state. 

Patients with important comorbidities undergoing extraction often experienced venous thrombosis and embolism. The extraction process itself may result in a prothrombotic state, and in addition, patients are not routinely placed on anticoagulation therapy following extraction due to bleeding... 

Lip GYH, Blann AD. Does hypertension confer a prothrombotic state Virchow s triad revisited. Circulation 2000 101(3) 218-20. 

Inflammation and cell proliferation are at the base of many chronic diseases and conditions, especially atherosclerosis and cancer, but also diabetes, hypertension, arthritis, mental health, and various autoimmune diseases. Individuals carrying genetic variants for these conditions are much more prone to develop them because the high n-6 n-3 ratio leads to proinflammatory and prothrombotic states. 

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