A 60-year-old woman with a history of diabetes mellitus has had left-sided chest pain radiating to the arm for the past 5 hours. Serial measurements of serum creatine kinase-MB levels show an elevated level 24 hours after the onset of pain. Partial thromboplastin time (PTT) and prothrombin time (PT) are normal. Coronary angiography shows occlusion of the left anterior descending artery. Which of the following mechanisms is the most likely cause of thrombosis in this patient?
Atherosclerotic damage to vascular endothelium is the most common cause of arterial thrombosis; this damage accumulates almost imperceptibly over many years. Diabetes mellitus types I and II accelerate atherosclerosis. Inhibitors to coagulation, such as antiphospholipid antibodies, typically prolong the partial thromboplastin time (PTT), the prothrombin time (PT), or both. Decreased levels of antithrombin III and mutation in the factor V gene are inherited causes of hypercoagulability; they are far less common than atherosclerosis of coronary vessels. Decreased production of tissue plasminogen activator from intact endothelial cells may occur in anoxia of the endothelial cells in veins with sluggish circulation. Stasis of blood flow is important in thrombosis within the low-pressure venous circulation.
Antibody inhibitor to coagulation
Damage to endothelium
Decreased antithrombin III level
Decreased tissue plasminogen activator
Hemodynamics