Patients with High levels of Circulating Endothelial Progenitor Cells (EPC) following at least three months of anticoagulation for unprovoked Venous Thromboembolism (VTE) are at low risk of recurrent VTE: Results from the ExACT Randomised Controlled Trial.

Charlotte Bradbury, Tracey Buckley, Yong Zhong Sun, Peter Rose, David Fitzmaurice

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background: There is clinical need for a laboratory biomarker to identify patients who, following an unprovoked venous thrombosis (VTE), are at low VTE recurrence risk and can discontinue anticoagulation after a limited treatment duration (3-6m). This secondary analysis of the ExACT study aimed to evaluate whether quantitation of peripheral blood endothelial progenitor cells(EPCs) could improve prediction of VTE recurrence risk.
Methods: The ExACT study was a non-blinded, multicentre RCT comparing extended vs discontinued anticoagulation following a first unprovoked VTE. Adult patients were eligible if they had completed ≥3 months anticoagulation and remained anticoagulated. The primary outcome was time to first recurrent VTE from randomisation. Blood samples were taken at baseline and results correlated with clinical outcome over 2 years follow up.
Findings: 281 patients were recruited, randomised (between July 2011 and February 2015) and followed up for 24 months (Male:Female 2:1, mean age 63). Of these, 273 patients were included in the final analysis. Blood samples were received at baseline for Full Blood Count(n=216), D-dimers(n=205) and endothelial progenitor cell (EPC) quantitation by flow cytometry(n=193). VTE recurrence was lower in the extended vs discontinued anticoagulation arms (5% vs 23%, HR 0.20(95%CI:0.09-0.46,p<0.001)). Level of EPCs were lower in patients who later developed VTE recurrence (43.41±7.69 cells/ml vs 87.1±7.15 cells/ml,p=0.02). Survival free from VTE recurrence was significantly improved in patients with EPCs≥100 cells/ml vs EPCs<100 cells/ml (HR 0.10(95%CI:0.01-0.75,p=0.025)).
Interpretation: If confirmed, EPC quantitation may represent a novel biomarker that identifies patients at low VTE recurrence risk who are suitable for limited duration anticoagulation.
Original languageEnglish
Article number100218
Number of pages9
JournalEClinicalMedicine
Volume17
DOIs
Publication statusPublished - 27 Nov 2019

Keywords

  • anticoagulation
  • D-dimers
  • endothelial progenitor cells
  • recurrence
  • venous thrombosis
  • VTE

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