NUR 03.2 - Relevance of Blood Coagulation Factors IX and X to Thrombin Generation Profile and Biomarkers of Thrombogenesis in Pulmonary Embolism Patients

Background: Pulmonary embolism, a pulmonary artery clot, is a catastrophic complication of venous thrombo-embolism. Coagulation Factor X is essential for clot formation. Intrinsic processes activate Factor IX subsequently activating FX, generating thrombin from prothrombin. Untreated PE has high morbidity and mortality rates. Nursing interventions (proper medication administration of anticoagulants and thrombolytics, assessments, and prevention education for recurrent thrombotic events) are fundamental for PE patient care.

Aims: The study investigated the relationship of FIX and FX levels to the thrombin generation profile (endogenous thrombin potential (ETP), peak thrombin, and Lag-time) and thrombogenesis biomarkers (D-Dimer, prothrombin fragment 1+2 (F1+2), thrombin antithrombin complex (TAT)). Biomarker levels would be compared to patient clinical outcomes and may reinforce nursing interventions.

Methods: At Loyola Medical Center, under an approved IRB, PE patients’ plasma samples (n=400) were collected. Healthy donor plasma (n=60) served as the control. ELISA assays measured FIX, FX, and thrombogenesis biomarkers. A calibrated automated thrombogram measured thrombin generation profile markers.

Results: Figure 1 shows biomarker levels versus healthy controls along with a correlation heat-map. FIX and FX showed a wider scattering compared to control. The thrombin generation profile showed a statistically significant decrease while thrombogenesis biomarkers showed significant increase versus the control. TAT strongly correlated with D-Dimer (r=0.43) and F1+2 (r=0.53). FIX moderately correlated with FX (r=0.26) and Lag-time (r=0.26). Eight biomarker levels were statistically analyzed against PE severity, 30-day mortality, and overall mortality. Table 1 shows FX, ETP, Peak thrombin, and three thrombogenesis biomarkers as statistically significant in the increasing degree of PE severity. FX was strongly associated with 30 day and overall mortality.

Conclusion(s): Biomarker levels suggest consumption of prothrombin due to increased thrombogenesis biomarkers and a decreased thrombin generation profile in PE patients. There are significant associations between relevant thrombotic biomarkers and FX compared to clinical outcomes for pulmonary embolism severity, 30-day, and overall patient mortality.