Increased P-Selectin Expression on Platelets and Decreased Plasma Thrombomodulin in Fontan Patients

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概要

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• Background: Thromboembolic events account for significant morbidity and mortality after the Fontan procedure, but the underlying mechanisms remain unclear. P-selectin on platelets indicates platelet activation. Thrombomodulin (TM), a receptor for thrombin and a major anticoagulant proteoglycan on the endothelial membrane, reflects the anticoagulant activity of the endothelium. The present study investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired in Fontan patients. Methods and Results: Platelet P-selectin as a marker of platelet activation, plasma TM levels and protein C activity, as markers of anticoagulant activity of the endothelium, and thrombin-antithrombin complex III (TAT) were examined in 43 Fontan patients. P-selectin levels on platelets (4.5 ±1.4 vs 3.4 ±0.4 mean fluorescence intensity, P<0.001) and TAT levels (80.2 ±322.6 vs 1.9 ±0.9 ng/ml, P<0.05) were significantly higher in Fontan patients than in control subjects. On the other hand, plasma TM levels (1.5 ±0.8 vs 2.2 ±0.3 FU/ml, P<0.01) and protein C activity (71 ±35 vs 118 ±25%, P<0.001) were significantly lower in Fontan patients compared with controls. These abnormalities were not seen in patients after other surgical procedures for congenital heart disease. Conclusions: Platelet activation is enhanced and endothelial function is impaired in patients after the Fontan procedure, which may partly explain the thromboembolic complications in Fontan patients. (Circ J 2009; 73: 1705-1710)

• 社団法人　日本循環器学会の論文
• 2009-08-20

著者

• Hagiwara Nobuhisa

  Department of Cardiology, Tokyo Women's Medical University

• Murasaki Kagari

  Department of Cardiology, Tokyo Women's Medical University

• Kawana Masatoshi

  Department Of Cardiology Tokyo Women's Medical University

• Kawana Masatoshi

  Department Of Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• NAKAZAWA MAKOTO

  Pediatric Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University

• KAJIMOTO Hidemi

  Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of M

• Nakanishi Toshio

  Department Of Pediatric Cardiology Heart Institute Tokyo Women's Medical University

• Kawana Masatoshi

  The Third Department Of Internal Medicine Faculty Of Medicine University Of Tokyo

• Murasaki Kagari

  Department Of Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• Hagiwara Nobuhisa

  Department Of Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• Murasaki Kagari

  Department Of Cardiology Tokyo Women's Medical University

• Nakazawa Makoto

  Pediatric And Lifelong Congenital Cardiology Institute Southern Tohoku General Hospital

• Kajimoto Hidemi

  Department Of Internal Medicine Division Of Cardio-vascular Medicine Kurume University School Of Med

• Kajimoto Hidemi

  Department Of Pediatric Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• Kurabayashi Masahiko

  The Third Department Of Internal Medicine Faculty Of Medicine University Of Tokyo

• Kawaguchi Masao

  Cardiac Division Departmet Of Internal Medicine National Cardiovascular Center

• Kawana Masatoshi

  Department Of Cardiology Tokyo Women' Medical University

• Nakanishi Toshio

  Department Of Pediatric Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• Murasaki Kagari

  Intensive And Cardiac Care Unit Nippon Medical School

• Murasaki Kagari

  Department Of Cardiorogy The Heart Institute Of Japan Tokyo Women's Medical University

• Nakayama Tomohiro

  Department Of Pediatrics Tokyo Women's Medical University

• Nakazawa Makoto

  Department Of Pediatric Cardiology Heart Institute Tokyo Women's Medical University

• Nakanishi Toshio

  Department Of Gastroenterology Miyoshi Central Hospital

• Kawana Masatoshi

  The First Department Of Internal Medicine Nippon Medical School

• Nakayama Tomohiro

  Department Of Pediatric Cardiology Heart Institute Of Japan Tokyo Women's Medical University

• Kajiya Masahito

  Department Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical University

• Nakayama Tomohiro

  Department Of Pediatric Cardiology Tokyo Women's Medical University

• Murai Koji

  Department Of Cardiology Tokyo Women' Medical University

• Kawana Masatoshi

  Department Of Cardiology The Heart Institute Of Japan Tokyo Women's Medical Universit

• Kawana Masatoshi

  The Heart Institute Of Japan Tokyo Women's Medical College

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