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Elevated soluble vascular cell adhesion molecule-1 levels at subacute phase of venous thromboembolism even after achievement of complete thrombolysis FREE TO VIEW

Satoshi Ota, MD*; Norikazu Yamada, MD; Akihiro Tsuji, MD; Ken Ishikura, MD; Mashio Nakamura, MD; Masaaki Ito, MD; Naoki Isaka, MD; Takeshi Nakano, MD
Author and Funding Information

The First Department of Internal Medicine, Mie University, Tsu, Japan


Chest. 2004;126(4_MeetingAbstracts):878S. doi:10.1378/chest.126.4_MeetingAbstracts.878S
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PURPOSE:  It has been considered that venous thromboembolism (VTE) and vascular endothelial cell inflammation are directly interrelated and are mediated in part by cell adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1). Purpose of this study is to prove the relationship between VTE and soluble form of VCAM-1(sVCAM-1) at acute or subacute phase.

METHODS:  We prospectively measured serum sVCAM-1 concentration at 23 consecutive patients diagnosed VTE (average age 55.2 ± 19.3 years old, 8 males) at acute phase (before treatment) and subacute phase (4 weeks after treatment). We also analyzed 8 healthy volunteers (average age 39.4±17.0 years old, 4 males) as control. Patients with obvious arteriosclerosis such as ischemic heart disease, cerebrovascular disease, diabetes mellitus and so on were excluded. The concentration of sVCAM-1 at acute phase was compared with that of controls. Patients were also measured d-dimer level at subacute phase and were classified into complete-thrombolysis(C) group (d-dimer<500 ng/ml) and incomplete-thrombolysis(I) group. Then the concentration of sVCAM-1 was compared at each group.

RESULTS:  The patients had significantly higher sVCAM-1 concentration than controls at acute phase (2522.8 ± 1274.2ng/ml vs 1353.4 ± 772.7ng/ml, p<0.01). The sVCAM-1 concentration of patients with acute pulmonary thromboembolism (APTE) had no difference from the patients without APTE (3085.3 ± 1628.4ng/ml vs 2222.8±973.9ng/ml p=0.2). At subacute phase, the patients kept high sVCAM-1 concentration (2097.1±878.0ng/ml) and there are no difference between C group and I group (1772.1±838.1ng/ml vs 2347.2±854.8ng/ml, p=0.1).

CONCLUSION:  This findings showed that the sVCAM-1 concentration of VTE patients was elevated at acute phase. This elevation was recognized at subacute phase whenever d-dimer elevated or not. This result indicates that the inflammation of vascular endothelial cell still continue until subacute phase in spite of achievement of complete thrombolysis.

CLINICAL IMPLICATIONS:  In our study, the inflammation persists in vascular endothelial cell at least for a month whenever thrombus had dissolved or not. Therefore we considered patients still have a high risk of VTE recurrence and need anticoagulation therapy at this period.

DISCLOSURE:  S. Ota, None.

Wednesday, October 27, 2004

12:30 PM- 2:00 PM




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