Comparison of acute and convalescent biomarkers of inflammation in patients with acute pulmonary embolism treated with systemic fibrinolysis vs. placebo

Lauren K. Stewart, Kristen E. Nordenholz, Mark Courtney, Christopher Kabrhel, Alan E. Jones, Matthew T. Rondina, Deborah B. Diercks, James R. Klinger, Jeffrey A. Kline

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)675-680
Number of pages6
JournalBlood Coagulation and Fibrinolysis
Volume28
Issue number8
DOIs
StatePublished - Dec 1 2017

Fingerprint

Fibrinolysis
Pulmonary Embolism
Biomarkers
Placebos
Inflammation
Plasminogen Activator Inhibitor 1
Hemostatics
C-Reactive Protein
Fibrinogen
Peroxidase
Interleukin-6
Carboxypeptidase B2
Venous Thromboembolism
Randomized Controlled Trials
Recurrence

Keywords

  • biomarkers
  • d-dimer
  • fibrinolysis
  • inflammation
  • pulmonary embolism

ASJC Scopus subject areas

  • Hematology

Cite this

Comparison of acute and convalescent biomarkers of inflammation in patients with acute pulmonary embolism treated with systemic fibrinolysis vs. placebo. / Stewart, Lauren K.; Nordenholz, Kristen E.; Courtney, Mark; Kabrhel, Christopher; Jones, Alan E.; Rondina, Matthew T.; Diercks, Deborah B.; Klinger, James R.; Kline, Jeffrey A.

In: Blood Coagulation and Fibrinolysis, Vol. 28, No. 8, 01.12.2017, p. 675-680.

Research output: Contribution to journalArticle

Stewart, Lauren K. ; Nordenholz, Kristen E. ; Courtney, Mark ; Kabrhel, Christopher ; Jones, Alan E. ; Rondina, Matthew T. ; Diercks, Deborah B. ; Klinger, James R. ; Kline, Jeffrey A. / Comparison of acute and convalescent biomarkers of inflammation in patients with acute pulmonary embolism treated with systemic fibrinolysis vs. placebo. In: Blood Coagulation and Fibrinolysis. 2017 ; Vol. 28, No. 8. pp. 675-680.
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