Abstract
Previous studies have associated biomarkers indicative of acute inflammation with pulmonary embolism, which may amplify coagulation, inhibit fibrinolysis and increase risk of venous thromboembolism (VTE) recurrence. The aim of this study was to measure inflammatory and hemostatic biomarkers in acute submassive pulmonary embolism at diagnosis and 3-month follow-up and to test the impact of treatment with fibrinolysis. Secondary analysis of a multicenter, double-blinded, randomized controlled trial including patients with submassive pulmonary embolism. Blood samples were obtained within 24 h of diagnosis and prior to bolus-dose tenecteplase (TNK) or placebo; all patients received standard anticoagulation and blood was redrawn 3 months later. Plasma concentrations of inflammatory [Interleukin 6 (IL-6), C-reactive protein (CRP), myeloperoxidase (MPO)] and hemostatic [plasminogen activator inhibitor-1 (PAI-1), fibrinogen, thrombin-Activatable fibrinolysis inhibitor and D-dimer] biomarkers were quantified. The median values of the biomarkers of inflammation (IL-6, CRP, MPO) were all significantly decreased at 3-month follow-up, ranging from a 60 to 91% reduction over this time period. Concentrations of PAI-1 and fibrinogen did not change significantly. d-dimer concentration at 3-month follow-up was lower in patients treated with fibrinolysis vs. placebo and appeared to have a trend toward significance (placebo 310 vs. TNK 220 ng/ml, P = 0.051). Acute pulmonary embolism causes marked but transient inflammation, as demonstrated by the significant elevation in the inflammatory biomarkers at diagnosis, followed by their reduction in more than 80% of patients at 3-month follow-up.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 675-680 |
| Number of pages | 6 |
| Journal | Blood Coagulation and Fibrinolysis |
| Volume | 28 |
| Issue number | 8 |
| DOIs | |
| State | Published - Dec 1 2017 |
Funding
A.E.J has received funding from the National Institutes of Health. D.B.D serves as a consultant for Daiichi Sankyo, Beckmann Coulter, Janssen and has received research support from Siemons, Alere, Roche and the National Institutes of Health. C.K. is a consultant for Diagnostica Stago, Siemens Healthcare and has received grant funding to his institution from Diagnostica Stago, Siemens Healthcare, the Harvard Milton Fund and the National Institutes of Health. J.A.K is a consultant for Stago Diagnostica, and has received funding from the Agency for Healthcare Reform, National Institutes for Health. Study funded by an investigator initiated grant from Genentech, Inc.
Keywords
- biomarkers
- d-dimer
- fibrinolysis
- inflammation
- pulmonary embolism
ASJC Scopus subject areas
- Hematology
