Impaired fibrinolysis in patients with blackfoot disease

Blackfoot disease is a unique endemic and chronic progressive arteriosclerotic vascular disease in southwest area of Taiwan. In this study, we determined the plasma levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI), urokinase plasminogen activator (uPA), and von Willebrand factor (vWF) antigen in Blackfoot disease patients, in comparison with normal controls from non-endemic areas and the endemic area, Putai. Blackfoot disease patients had mean tPA antigen level of 7.9 ng/ml (n = 27) which was significantly lower (p < 0.05) than both the normal controls with 11.0 ng/ml (n = 20) and the Putai normal controls with 9.7 ng/ml (n = 39). However, the mean PAI-1 antigen level in the patient group was 41.2 ng/ml (n = 28) which was significantly higher (p = 0.0001) than both the normal controls with 19.7 ng/ml (n = 23) and the Putai normal controls with 21.3 ng/ml (n = 40). Furthermore, in the patient group, a significantly lower (p < 0.005) mean uPA antigen level (2.3 ng/ml, n = 18) was noted as compared with that in the normal controls (3.2 ng/ml, n = 14). No significant difference was observed in vWF antigen level between patients and normal controls. This study suggests that a reduced capacity for fibrinolysis is associated with Blackfoot disease.