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Thromb Haemost 2022; 122(03): 434-444
DOI: 10.1055/s-0041-1739193
Atherosclerosis and Ischaemic Disease

Incorporation of Fibrin, Platelets, and Red Blood Cells into a Coronary Thrombus in Time and Space

Martin Maly
1   First Faculty of Medicine, Department of Medicine, Charles University in Prague and Military University Hospital, Prague, Czech Republic
,
Tomas Riedel
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
3   Chemistry and Physics of Surfaces and Biointerfaces, Institute of Macromolecular Chemistry, Czech Academy of Sciences, Prague, Czech Republic
,
Jana Stikarova 
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
,
Jiri Suttnar
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
,
Roman Kotlin
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
,
Martin Hajsl
1   First Faculty of Medicine, Department of Medicine, Charles University in Prague and Military University Hospital, Prague, Czech Republic
,
Petr Tousek
4   Cardiocenter, University Hospital Kralovske Vinohrady and Third Medical Faculty, Charles University, Prague, Czech Republic
,
Jirina Kaufmanova
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
5   Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Prague, Czech Republic
,
Ondrej Kucerka
1   First Faculty of Medicine, Department of Medicine, Charles University in Prague and Military University Hospital, Prague, Czech Republic
,
John W. Weisel
6   Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Jan E. Dyr   †
2   Department of Biochemistry, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
› Author Affiliations Funding This work was supported by the Ministry of Health, Czech Republic (grant numbers 00023736 and NV18–08–00149), Czech Science Foundation [grant numbers P205/12/G118 and 19–02739S]), and by European Regional Development Fund and the state budget of the Czech Republic (project AIIHHP: CZ.02.1.01/0.0/0.0/16_025/0007428, OP RDE, Ministry of Education, Youth and Sports), as well as a National Institutes of Health grant (HL148227) and the University of Pennsylvania Research Foundation.
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Abstract

We describe the internal structure, spatial organization and dynamic formation of coronary artery thrombi from ST-segment elevation myocardial infarction patients. Scanning electron microscopy (SEM) revealed significant differences among four groups of patients (<2 hours; 2–6 hours; 6–12 hours, and >12 hours) related to the time of ischemia. Coronary artery thrombi from patients presenting less than 2 hours after the infarction were almost entirely composed of platelets, with small amounts of fibrin and red blood cells. In contrast, thrombi from late presenters (>12 hours) consisted of mainly platelets at the distal end, where clotting was initiated, with almost no platelets at the proximal end, while the red blood cell content went from low at the initiating end to more than 90% at the proximal end. Furthermore, fibrin was present mainly on the outside of the thrombi and older thrombi contained thicker fibers. The red blood cells in late thrombi were compressed to a close-packed, tessellated array of polyhedral structures, called polyhedrocytes. Moreover, there was redistribution from the originally homogeneous composition to fibrin and platelets to the outside, with polyhedrocytes on the interior. The presence of polyhedrocytes and the redistribution of components are signs of in vivo clot contraction (or retraction). These results suggest why later thrombi are resistant to fibrinolytic agents and other treatment modalities, since the close-packed polyhedrocytes form a nearly impermeable seal. Furthermore, it is of particular clinical significance that these findings suggest specific disparate therapies that will be most effective at different stages of thrombus development.

Keywords

coronary - aspiration thrombectomy - scanning electron microscopy - ST-segment elevation myocardial infarction

† Demised.


Author Contributions

M. Maly designed the study, participated in the collection of samples and writing of the article; T. Riedel, J. Suttnar, R. Kotlin, and J. Kaufmanova participated in the analysis and interpretation of data; J. Stikarova participated in the analysis and interpretation of data and writing of the article; P. Tousek and O. Kucerka participated in the design of the study and collection of samples; J. W. Weisel participated in the concept and design of the study and writing of the article; Jan E. Dyr participated in the concept and design of the study, interpretation of data, and writing of the article.




Publication History

Received: 19 May 2021

Accepted: 26 September 2021

Article published online:
15 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Not All Thrombi Are Created Equal: Understanding Thrombus Structure on the Time–Space ContinuumThromb Haemost 2022; 122(03): 315-315
DOI: 10.1055/a-1695-8813

 

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