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.
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.
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).
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.
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.
S. Ota, None.