Fibrinolytic Activity in Patients with Newly Diagnosed Multiple Myeloma

Aim: Coagulation and fibrinolysis are in balance in the normal hemostatic system, and disruption of this balance can result in bleeding disorders or thrombotic events.Studies on the fibrinolytic system in patients with multiple myeloma (MM) are few in number and have yielded conflicting results.Impaired fibrinolysis may contribute to the development of thrombotic complications in these patients.To measure levels of the fibrinolysis activator, tissue plasminogen activator (tPA) and the major fibrinolysis inhibitors, plasminogen activator inhibitor-1 (PAI-1) and thrombin-activatable fibrinolysis inhibitor (TAFI) in MM patients and compare with a control group.Methods: The study group included 48 newly diagnosed, previously untreated MM patients who presented to the Hematology Outpatient Clinic of Zonguldak Blent Ecevit University Faculty of Medicine for 20 months.The control group consisted of 20 individuals with no systemic disease who presented to the general internal medicine outpatient clinic for routine check-ups.Results: Mean plasma tPA level was 9 (6.58-15.36)ng/mL in the patient group and 12.35 (8.4-19.7)ng/mL in the control group (p=0.221).Plasma PAI-1 level was 9.36 (1.28) ng/mL in the patient group and 9.56 (0.26) ng/mL in the control group (p=0.057).Plasma TAFI level was significantly lower in the patient group [7.6 (6.2-9.19)g/mL] compared to the control group [9.46 (8.83-13.02)g/mL] (p<0.001) but was not correlated with disease stage.There was no statistically significant difference in plasma D-dimer levels between the MM patients and the control group (p=0.406). Conclusion:While impaired fibrinolytic activity is expected in MM patients, our results demonstrated that MM patients had low TAFI levels without significant changes in tPA and PAI-1 levels.Decreased TAFI levels may play a role in other mechanisms that can cause bleeding in MM patients.