학술논문
Reduced fibrin clot permeability on admission and elevated E-selectin at 3 months as novel risk factors of residual pulmonary vascular obstruction in patients with acute pulmonary embolism
Document Type
Original Paper
Author
Source
Journal of Thrombosis and Thrombolysis: A Journal for Translation, Application and Therapeutics in Thrombosis and Vascular Science. 57(2):248-259
Subject
Language
English
ISSN
1573-742X
Abstract
Background: Residual pulmonary vascular obstruction (RPVO) is common following pulmonary embolism (PE) but its association with fibrin clot properties is poorly understood. We investigated whether prothrombotic state and hypofibrinolysis markers can identify patients with RPVO.Methods: In 79 normotensive noncancer patients (aged 56 ± 13.3 years) with acute PE, we determined fibrin clot permeability (Ks ), clot lysis time (CLT), endogenous thrombin potential (ETP), fibrinolysis proteins, oxidative stress markers, and E-selectin on admission before initiation of anticoagulant therapy, after 5–7 days, and 3 months of anticoagulation. RPVO was diagnosed using computed tomography angiography 3–6 months since PE.Results: Patients with RPVO (n = 23, 29.1%) had at baseline higher simplified Pulmonary Embolism Severity Index (sPESI) (P = 0.004), higher N-terminal brain natriuretic propeptide (P = 0.006) and higher D-dimer (P = 0.044). Patients with versus without RPVO had lower Ks (P < 0.001) and longer CLT (P < 0.05), both at baseline and 5–7 days since admission, but not at 3 months. Patients with RPVO showed 40.6% higher E-selectin (P < 0.001) solely at 3 months. By multivariable logistic regression, baseline Ks (odds ratio [OR] 0.010, 95% confidence interval [CI] 0.001–0.837, P = 0.042, per 10− 9 cm2 ), baseline D-dimer (OR 1.105, 95% CI 1.000-1.221, P = 0.049, per 100 ng/ml), and E-selectin levels after 3 months (OR 3.874, 95% CI 1.239–12.116, P = 0.020, per 1 ng/ml) were associated with RPVO.Conclusions: RPVO patients despite anticoagulation characterize with the formation of denser fibrin clots on admission and higher E-selectin at 3 months. Those parameters could be the potential novel RPVO risk factors that warrant further evaluation in an independent cohort.Graphical Abstract:
Key points: RPVO occurs in a large proportion of acute PE patients despite anticoagulation.Plasma fibrin clot permeability and lysability on admission and after 5–7 days are potential novel RPVO risk factors.Elevated E-selectin after 3 months since PE was observed in RPVO patients.E-selectin inhibitors are potentially attractive in the RPVO prevention in PE patients.
Key points: RPVO occurs in a large proportion of acute PE patients despite anticoagulation.Plasma fibrin clot permeability and lysability on admission and after 5–7 days are potential novel RPVO risk factors.Elevated E-selectin after 3 months since PE was observed in RPVO patients.E-selectin inhibitors are potentially attractive in the RPVO prevention in PE patients.