MBRACE subanalysis links Lp(a) to tensile clot strength and oxidized phospholipids (Arterioscler Thromb Vasc Biol 2026)

Original title: Lipoprotein(a), Oxidized Phospholipids and Tensile Clot Strength Measured by Thromboelastography in Patients Undergoing Percutaneous Intervention

Arterioscler Thromb Vasc Biol · 20 August 2026 · 5

Gurbel PA, Tantry US, Bliden KP, Ashley WW, Jeong YH, Tsimikas S

In a subanalysis of the MBRACE trial, researchers measured Lp(a), oxidized phospholipid (OxPL) biomarkers, and tensile clot strength (TCS) in patients with multivessel coronary artery disease, myocardial infarction, or ischemic stroke undergoing percutaneous intervention, alongside 17 healthy subjects. Patients had significantly higher Lp(a), OxPL-apoB, OxPL-apo(a), and TCS than healthy controls. Black patients and females exhibited higher Lp(a) and OxPL levels, with Black females showing the highest values. Multivariate analysis linked hypercoagulability (TCS ≥66.5 mm) to Lp(a), OxPL-apoB, and total plasminogen, while high Lp(a) (≥125 nmol/L) correlated with OxPL-apoB and OxPL-apo(a). This observational subanalysis provides mechanistic insight into how Lp(a) and OxPL drive hypercoagulability, though causal inference remains limited by its cross-sectional design.

Original abstract

Background: Lp(a) (lipoprotein[a]) and tensile clot strength (TCS) are distinct and independent risk factors for incident cardiovascular disease and recurrent ischemic events. Lp(a) is a carrier of oxidized phospholipids (OxPL) that contribute to its atherothrombotic properties. The current objective is to study the relationship of Lp(a) and OxPL biomarkers with TCS in patients with high-risk vascular diseases.

Methods: In a subanalysis of the ongoing MBRACE trial (Multidisciplinary Approach to Reduce Cardiovascular Health Disparities in the Baltimore Racial Minority Communities), we studied Lp(a), OxPL biomarkers, and TCS in healthy subjects (n=17) and in patients with cardiovascular disease undergoing percutaneous intervention (multivessel coronary artery disease [n=60], myocardial infarction [n=86], and ischemic stroke [n=28]). Lp(a), OxPL-apoB, OxPL-apo(a), OxPL-plasminogen (OxPL-PLG), and total plasminogen were measured using enzyme-linked immunoassays. High Lp(a) was defined as ≥125 nmol/L. TCS was measured by thromboelastography, and hypercoagulability was defined by values ≥66.5 mm.

Results: Compared with healthy subjects, patients had higher Lp(a), OxPL-apoB, OxPL-apo(a), and TCS (P<0.05 for all). Black patients, compared with White patients, had higher Lp(a), OxPL biomarkers, and TCS (P≤0.05); whereas females had higher Lp(a) and OxPL biomarkers except OxPL-PLG (P≤0.03) and numerically higher TCS (P=0.06). Black females had the highest Lp(a), OxPL-apoB, OxPL-apo(a), and TCS (P≤0.05). In a multivariate analysis, hypercoagulability was associated with Lp(a), OxPL-apoB, and total plasminogen (P≤0.019), whereas high Lp(a) was associated with OxPL-apoB and OxPL-apo(a) (≤0.004).

Conclusions: In patients with high-risk cardiovascular disease undergoing percutaneous intervention, Lp(a), OxPL-related biomarkers, and TCS are influenced by race and gender and correlated with hypercoagulability. These findings suggest novel mechanistic insights into the relationship between Lp(a), OxPL biomarkers, and the propensity for whole-blood clotting and may be relevant in explaining the outcomes of patients in ongoing trials targeting the reduction of Lp(a).

Summary written by lp-a.org from the published abstract; figures as published. Page updated 22 August 2026. Methods.