Platelet-Monocyte Aggregates and C-Reactive Protein are Associated with VTE in Older Surgical Patients.
Emerging evidence implicates platelets as key mediators of venous thromboembolism (VTE). Nevertheless, the pathways by which platelets and circulating procoagulant proteins synergistically orchestrate VTE remain incompletely understood. We prospectively determined whether activated platelets and systemic procoagulant factors were associated with VTE in 32 older orthopedic surgery patients. Circulating platelet-monocyte aggregates (PMAs), p-selectin expression (P-SEL), and integrin αIIbβ3 activation (PAC-1 binding) were assessed pre-operatively and 24 hours post-operatively. The proinflammatory and procoagulant molecule C-reactive protein (CRP), which induces PMA formation in vitro, along with plasma d-dimer and fibrinogen levels were also measured. The primary outcome was VTE occurring within 30 days post-operatively. Overall, 40.6% of patients developed VTE. Patients with VTE had a significant increase in circulating PMAs and CRP post-operatively, compared to those without VTE. Changes in PMA and CRP in VTE patients were significantly correlated (r(2) = 0.536, p = 0.004). In contrast, P-SEL expression and PAC-1 binding, fibrinogen levels, and d-dimers were not associated with VTE. This is the first study to identify that increased circulating PMAs and CRP levels are early markers associated with post-surgical VTE. Our findings also provide new clinical evidence supporting the interplay between PMAs and CRP in patients with VTE.
Department of Internal Medicine, University of Utah, Salt Lake City, USA.
Lauren
L
Shih
Department of Internal Medicine, University of Utah, Salt Lake City, USA.
David
D
Kaplan
Division of Vascular Surgery, University of Utah, Salt Lake City, USA.
Larry W
LW
Kraiss
Study Design and Biostatistics Center, University of Utah, Salt Lake City, USA.
T Charles
TC
Casper
Department of Internal Medicine, University of Utah, Salt Lake City, USA.
Robert C
RC
Pendleton
Department of Orthopedic Surgery, University of Utah, Salt Lake City, USA.
Christopher L
CL
Peters
Division of Geriatrics, University of Utah, Salt Lake City, USA.
Mark A
MA
Supiano
Department of Internal Medicine, University of Utah, Salt Lake City, USA.
Guy A
GA
Zimmerman
Department of Internal Medicine, University of Utah, Salt Lake City, USA.|Molecular Medicine Program at the University of Utah Health Sciences Center, Salt Lake City, Utah.
Andrew S
AS
Weyrich
Department of Internal Medicine, University of Utah, Salt Lake City, USA.|Molecular Medicine Program at the University of Utah Health Sciences Center, Salt Lake City, Utah.|George E. Wahlen Salt Lake City VAMC GRECC, Salt Lake City, USA.
Matthew T
MT
Rondina
D000368:Aged; D001792:Blood Platelets / Q000166:cytology*; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000097:blood*
D002097:C-Reactive Protein