doi: 10.1161/01.ATV.0000199298.80771.1f
© 2006 American Heart Association, Inc.
Letters to the Editor |
Letter to the Editor
Assessment of Hemostatic Risk Factors in Predicting Arterial Thrombotic Events
Hemostasis, Thrombosis, and Vascular Biology Unit University Department of Medicine, City Hospital Birmingham, United Kingdom
To the Editor:
We read with interest the excellent article by Feinbloom and Bauer outlining several key hemostatic risk factors that may be predictive of arterial thrombotic events.1 We do appreciate that there are a wide range of key hemostatic risk factors involved in atherothrombosis, but their article has little mention of the evolving interest into fibrin D-dimer as an index of thrombogenesis, as well as the many endothelial specific vascular markers that have been intimately related to hemostasis and thrombosis, and have been shown to predictive of future cardiovascular events.
For example, plasma von Willebrand factor (vWF) is already a well-established plasma marker of endothelial damage/dysfunction. vWF is important in mediating platelet aggregation, suggesting a possible contributory prothrombotic role. Our group has previously shown that raised levels of vWF are predictive of thrombosis-related vascular events, such as ischemic stroke among patients with atrial fibrillation,2 and major adverse cardiac events (MACEs) among patients presenting with acute coronary syndrome (ACS).3 Another endothelial marker is soluble E-selectin (sE-sel), which is an endothelial-specific membrane-bound adhesion molecule that is normally not expressed by resting endothelial cells, so raised plasma levels indicate endothelial activation. Increased sE-sel levels have also been shown to be predictive of future arterial thrombotic events.4,5
As a relatively new "marker" predictive of thrombotic events, immunologically defined CD146-bearing circulating endothelial cells (CECs) is rapidly gaining ground as a novel and specific endothelial marker. CECs are thought to represent mature endothelial cells or endothelial cell fragments that have detached (or have been driven from) from the mural endothelium in response to a particular injurious process(es). Our group has recently shown that endothelial specific CECs measured from peripheral venous blood at 48 hours were the only independent predictor of death and MACE at 30 days and 1 year among a cohort of 156 patients presenting with ACS.3
We would also highlight interest into fibrin D-dimer, which has long been proposed as a useful clinical marker of thrombogenesis.6 In atrial fibrillation, which is a common arrhythmia associated with a substantial risk of stroke and thromboembolism, high levels of fibrin D-dimer, even despite oral anticoagulation therapy, are significant predictors of cardiovascular events.7 Similar observations on the prognostic value of fibrin D-dimer in peripheral artery disease have long been noted.8
References
- Feinbloom D, Bauer KA. Assessment of hemostatic risk factors in predicting arterial thrombotic events. Arterioscler Thromb Vasc Biol. 2005; 25: 2043–2053.
[Abstract/Free Full Text] - Conway DS, Pearce LA, Chin BS, Hart RG, Lip GY. Prognostic value of plasma von Willebrand factor and soluble P-selectin as indices of endothelial damage and platelet activation in 994 patients with nonvalvular atrial fibrillation. Circulation. 2003; 107: 3141–3145.
[Abstract/Free Full Text] - Lee KW, Lip GY, Tayebjee M, Foster W, Blann AD. Circulating endothelial cells, von Willebrand factor, interleukin (IL)-6, and prognosis in patients with acute coronary syndromes. Blood. 2005; 105: 526–532.
[Abstract/Free Full Text] - Suefuji H, Ogawa H, Yasue H, Sakamoto T, Miyao Y, Kaikita K, Soejima H, Misumi K, Miyamoto S, Kataoka K. Increased plasma level of soluble E-selectin in acute myocardial infarction. Am Heart J. 2000; 140: 243–248.[CrossRef][Medline] [Order article via Infotrieve]
- Mohan JS, Lip GY, Wright J, Bareford D, Blann AD. Plasma levels of tissue factor and soluble E-selectin in sickle cell disease: relationship to genotype and to inflammation. Blood Coagul Fibrinolysis. 2005; 16: 209–214.[Medline] [Order article via Infotrieve]
- Lip GY, Lowe GD. Fibrin D-dimer: a useful clinical marker of thrombogenesis? Clin Sci (Lond). 1995; 89: 205–214.[Medline] [Order article via Infotrieve]
- Vene N, Mavri A, Kosmelj K, Stegnar M. High D-dimer levels predict cardiovascular events in patients with chronic atrial fibrillation during oral anticoagulant therapy. Thromb Haemost. 2003; 90: 1163–1172.[Medline] [Order article via Infotrieve]
- Komarov A, Panchenko E, Dobrovolsky A, Karpov Y, Deev A, Titaeva E, Davletov K, Eshkeeva A, Markova L. D-dimer and platelet aggregability are related to thrombotic events in patients with peripheral arterial occlusive disease. Eur Heart J. 2002; 23: 1309–1316.
[Abstract/Free Full Text]
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