Mechanisms
A case of Lp(a) at 925 nmol/L with recurrent cardiovascular events and a confirmed hypercoagulable profile despite optimal therapy (Front Cardiovasc Med 2026)
Original title: Pathogenic interplay between markedly elevated plasma lipoprotein(a) levels and prothrombotic mechanisms: a case report
This case report describes a 64-year-old woman with markedly elevated lipoprotein(a), 925 nmol/L against a reference range below 105 nmol/L, and a history of recurrent major cardiovascular events despite optimal lipid-lowering and antiplatelet therapy. Comprehensive functional haemostasis testing confirmed a hypercoagulable profile: enhanced thrombin generation, reduced sensitivity to thrombomodulin, platelet hyperreactivity, and increased clot firmness on thromboelastometry, with residual platelet activity despite antiplatelet treatment. The authors propose that markedly elevated Lp(a) may drive a prothrombotic phenotype that compounds its atherogenic effect, and suggest global coagulation and platelet function assays could help identify patients who might benefit from tailored antithrombotic strategies. A single-patient report, hypothesis-generating rather than definitive.
Original abstract
Lipoprotein(a) [Lp(a)] is a well-established genetic risk factor for atherosclerotic cardiovascular disease, though its role as a prothrombotic risk factor remains only partially understood. We report the case of a 64-year-old woman with markedly elevated Lp(a) levels (925 nmol/L, reference range < 105 nmol/L) and a history of recurrent major cardiovascular events, despite optimal lipid-lowering and antiplatelet therapies. We confirmed a hypercoagulable profile via comprehensive functional assessment of hemostasis: enhanced thrombin generation, reduced sensitivity to thrombomodulin, platelet hyperreactivity, and increased clot firmness at thromboelastometry - with residual platelet activity despite antiplatelet treatment. This case suggests a possible association between markedly elevated plasma Lp(a) levels and a hypercoagulable profile, which may enhance atherogenesis. Global coagulation and platelet function assays may help identify high-risk patients with elevated Lp(a) levels who may benefit from tailored antithrombotic strategies.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.