title: Coagulopathy in patients with acute pulmonary embolism: a pilot study of whole blood coagulation and markers of endothelial damage.
abstract: Whole blood coagulation and markers of endothelial damage were studied in patients with acute pulmonary embolism (PE), and evaluated in relation to PE severity. Twenty-five patients were enrolled prospectively each having viscoelastical analysis of whole blood done using thrombelastography (TEG) and Multiplate aggregometry. Fourteen of these patients were investigated for endothelial damage by ELISA measurements of Syndecan-1 (endothelial glycocalyx degradation), soluble endothelial Selectin (endothelial cell activation), soluble Thrombomodulin (endothelial cell injury) and Histone Complexed DNA fragments (endothelial cytotoxic histones). The mean values of TEG and Multiplate parameters were all within the reference levels, but a significant difference between patients with high and intermediate risk PE was observed for Ly30 (lytic activity) 1.5% [0-10] vs. 0.2% [0-2.2] p = .04, and ADP (platelet reactivity) 92 U [20-145] vs. 59 U [20-111] p = .03. A similar difference was indicated for functional fibrinogen 21 mm [17-29] vs. 18 mm [3-23] p = .05. Analysis of endothelial markers identified a significant difference in circulating levels between high and intermediate risk PE patients for Syndecan-1 118.6 ng/mL [76-133] vs. 36.3 ng/mL [11.8-102.9] p = .008. In conclusion, patients with acute PE had normal whole blood coagulation, but high risk PE patients had signs of increased activity of the haemostatic system and significantly increased level of endothelial glycocalyx degradation.
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Lehnert
authors.affiliation: b Section for Transfusion Medicine , Capital Region Blood Bank , Copenhagen , Denmark.|c Department of Surgery , University of Texas Health Medical School , Houston , TX , USA.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: b Section for Transfusion Medicine , Capital Region Blood Bank , Copenhagen , Denmark.
authors.forename: Sisse R
authors.initials: SR
authors.lastname: Ostrowski
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Møller
authors.affiliation: d Department of Cardiology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Lia E
authors.initials: LE
authors.lastname: Bang
authors.affiliation: a Department of Cardiothoracic Surgery , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Peter Skov
authors.initials: PS
authors.lastname: Olsen
authors.affiliation: d Department of Cardiology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Carlsen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology*; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000737:chemistry / Q000473:pathology*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D019276:Glycocalyx / Q000737:chemistry / Q000473:pathology; D006657:Histones / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010974:Platelet Aggregation; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D012720:Severity of Illness Index; D053668:Syndecan-1 / Q000097:blood*; D013916:Thrombelastography; D018180:Thrombomodulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D019040:E-Selectin; D006657:Histones; C508241:SDC1 protein, human; D053668:Syndecan-1; C546931:THBD protein, human; D018180:Thrombomodulin; D005340:Fibrinogen
keywords: Acute disease; endothelial cells; platelet function tests; pulmonary embolism; risk; syndecan-1; thrombelastography