Fibrinolytic Deficit in Patients With Acute PE

Study Overview
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Brief Summary
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Fibrinolysis is the body's process that prevents blood clots. The investigators hypothesize that patients presenting with acute pulmonary embolism (PE) or blood clots in the lungs differ in their fibrinolytic deficit phenotype. The investigators aim to use biomarkers directly involved in endogenous fibrinolytic cascade including PAI-1, Alpha-2-Antiplasmin (A2A), TAFI, D-dimer, and Fibrinogen to phenotypically characterize patients presenting with acute PE and to correlate these biomarkers with clinical, echocardiographic, computed tomography (CT), and functional status outcomes.

Detailed Description
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Patients (n=100) identified by the Pulmonary Embolism Response Team (PERT) suffering from a PE will be identified by the PI. Blood plasma samples from these patients which have been drawn for routine lab tests will be identified and the Sub-I who will pick the samples up from the clinical lab after the routine analysis has been completed. These samples will be de-identified by giving them a study number. These samples will be recentrifuged and aliquoted. Samples will be stored in a -80ᵒC freezer in the Hemostasis & Thrombosis Research Laboratory. When all 100 de-identified samples have been collected they will be analyzed blindly by the technical staff of the hemostasis laboratory for the fibrinolytic parameters PAI-1, Alpha-2-Antiplasmin, TAFI, tPA, D-dimer, Plasminogen, and Fibrinogen. PAI-1 and TAFI will be quantified with an Enzyme Linked-Immuno-Sorbent Assay (ELISA), while A2A is measured using functional assay. PAI-1 is measured as ug/ml, while TAFI and A2A are measured as % of normal controls. Normal controls are derived from pooled normal human plasma from volunteers purchased from outside vendor. Results will be compiled and sent to the PERT team for analysis and correlation withclinical, echocardiographic, computed tomography (CT), and functional status outcomes.

Official Title
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Fibrinolytic Deficit in Patients With Acute Pulmonary Embolism

Conditions
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Acute Pulmonary Embolism, Fibrinolytic Deficit

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients age 18 - 90 years Patients suffering an acute PE Blood collected for clinical evaluation of PE Exclusion Criteria: Blood not collected or not sufficient quantity/quality

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasminogen Activator Inhibitor-1 (PAI-1) | Laboratory analysis of blood sample for PAI-1 level | Baseline-Day 1 | 
| Alpha-2 Antiplasmin level (A2P) | Laboratory analysis of blood sample for A2P level | Baseline-Day 1 | 
| Thrombin Activatable Fibrinolysis Inhibitor (TAFI) | Laboratory analysis of blood sample for TAFI level | Baseline-Day 1 | 
| Tissue plasminogen activator (tPA) | Laboratory analysis of blood sample for tPA level | Baseline-Day 1 | 
| D-dimer | Laboratory analysis of blood sample for D-dimer level | Baseline-Day 1 | 
| Plasminogen | Laboratory analysis of blood sample for Plasminogen level | Baseline-Day 1 | 
| Fibrinogen | Laboratory analysis of blood sample for Fibrinogen level | Baseline-Day 1 | 
| Clinical Presentation Risk Score | Based on vital signs (heart rate, blood pressure, oxygen requirements, and labs (CBC, lactate, troponin, and BNP, clinical presentation will be characterized as low, intermediate, or high risk. | Baseline-Day 1 | 
| Right Ventricular Function | Assessed by echocardiography | Baseline-Day 1 | 
| Pulmonary Artery Pressure | Pulmonary Artery Pressure (mmHg) will be measured for patients escalated to endovascular therapies in the cardiac cath laboratory | Baseline-Day 1 | 
| Cardiac Output | Cardiac Output, the volume of blood pumped from the ventricle per heartbeat (mL/min), will be measured for patients escalated to endovascular therapies in the cardiac cath laboratory. | Baseline-Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Pulmonary Embolism, Fibrinolytic System, Fibrinolysis