Background Arterial and venous thromboembolism were proven to be increased in cases with rheumatoid arthritis (RA) (1). It would be interesting to predict thrombosis in these patients by a laboratory test. Rotational thromboelastography (ROTEM) is a viscoelastometric clotting test to evaluate the kinetics of clot formation and fibrinolysis which provides global information on cellular and soluble procoagulant/anticoagulant protein interactions.
Objectives Our aim was to determine the thrombosis predisposition in RA patients by thromboelastography and to identify the possible clinical and laboratory risk factors for thrombotic tendency in RA patients.
Methods 85 RA patients (mean age: 54.12±13 yrs; female: 66 (77.6%) diagnosed based on 2010 ACR/EULAR classification criteria were sequentially recruited. Patients were receiving either conventional synthetic disease modifying antirheumatic drugs (csDMARD) or were receiving biological treatments. Age- and gender matched 35 healthy individuals were enrolled as a control group. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured and DAS-28 scores were calculated. ROTEM was applied at the same time and clotting time (CT, seconds), clot formation time (CFT, seconds), and maximum clot firmness (MCF, mm) were determined. A shorter CT and/or CFT values and/or a higher MCF levels imply tendency towards hypercoagulability.
Results RA patients with a higher disease activity were found to have a shorter I-CFT and a higher I-MCF (p values p=0.020, p=0.033, respectively). Correlation analysis revealed shorter I-CFT and E-CFT and higher I-MCF and E-MCF in those with more active disease, hence indicating a higher tendency to thrombosis. DAS-28 score, high level of CRP, and increased platelet count were identified as variants affecting thromboelastography in favor of thrombosis susceptibility.
Conclusions Disease activation in RA patients may lead to hypercoagulability, independent of the ongoing medication of patients. Considering the fact that the predictive value of ROTEM parameters for further thrombosis, additional studies are needed whether pro-thrombotic state in RA may herald thrombosis in the presence of inflammation.
Mameli A, Barcellona D, Marongiu F. Rheumatoid arthritis and thrombosis. Clin Exp Rheumatol. 2009;27:846–55.
Disclosure of Interest None declared