Does endothelium agree with the concept of idiopathic hepatic vessel thrombosis?
OBJECTIVE
To investigate the major steps of thrombogenesis and to identify the differences in these steps between idiopathic patient group and control group.


METHODS
Fibrinogenesis was studied by measuring the activated factor VII, total and free levels of tissue factor pathway inhibitor (TFPI). The fibrinolysis step was investigated by determining the global fibrinolytic capacity. The endothelial function was assessed by measuring the levels of soluble adhesion molecules, namely soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1 (sVCAM-1) and soluble E-selectin molecule. The exclusion criteria from "idiopathic" patient group were abdominal surgery, pregnancy, use of oral contraceptives, anti-phospholipid syndrome, Behçet's disease, cancer, myeloproliferative diseases. The congenital factors like mutations of factor-V Leiden and prothrombin, deficiencies of proteins C and S, antithrombin, hyperhomocysteinemia and hyperfibrinogenemia were ruled out. The total number of patients was reduced from 96 to 9 (7 with portal vein thrombosis, 2 Budd Chiari syndrome) by exclusion criteria.


RESULTS
The levels of adhesion molecules sICAM-1, sVCAM-1, free TFPI levels and global fibrinolytic capacity were significantly different (P<0.05) in the patient group indicating an endothelial dysfunction and a lower fibrinolytic activity.


CONCLUSIONS
These results show that this patient group should be tested by means of endothelial dysfunction and managed differently.
Department of Gastroenterology, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey. ozgurmd@hacettepe.edu.tr
Ozgur
O
Harmanci
Yahya
Y
Buyukasik
Serafettin
S
Kirazli
Ferhun
F
Balkanci
Yusuf
Y
Bayraktar
D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D006502:Budd-Chiari Syndrome / Q000097:blood / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D018450:Disease Progression; D019040:E-Selectin / Q000097:blood / Q000502:physiology; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005167:Factor VII / Q000032:analysis / Q000502:physiology; D005260:Female; D005342:Fibrinolysis; D005355:Fibrosis / Q000503:physiopathology; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood / Q000502:physiology; D008074:Lipoproteins / Q000097:blood / Q000502:physiology; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood / Q000502:physiology
D019040:E-Selectin; D008074:Lipoproteins; D019010:Vascular Cell Adhesion Molecule-1; C051928:lipoprotein-associated coagulation inhibitor; D018799:Intercellular Adhesion Molecule-1; D005167:Factor VII