The results of the current study indicated that P-selectin concentration was significantly higher in the group of patients with thrombosis as compared to the healthy controls. The three groups under investigation were found to be significantly different in terms of mean D-Dimer and mean P-selectin concentrations. The results also demonstrated a positive correlation between P-selectin and D-Dimer levels in the pregnant women. Moreover, logistic regression revealed that from among the factors associated with the incidence of thrombosis, P-selectin and D-Dimer were the good predictive factors for thrombosis in the pregnant women. Finally, it was observed that high Wells score was associated with higher levels of P-selectin.
Thrombosis and embolism mainly occur during pregnancy and the postpartum period. Their incidence rate is particularly high during the postpartum period. P-selectin plays a key role in the pathophysiology of thrombosis. The effects of the high level of soluble P-selectin (sP-selectin) on VTE have not been determined yet. Some researchers have explored the relationship between sP-selectin and VTE. Some others have assessed sP-selectin as a predictive factor for acute thrombosis. The results, however, are mixed and inconsistent.
P-selectin is expressed on the surface of activated platelets and endothelial cells. It has been reported to trigger the adhesion of platelets to monocytes and neutrophils. This protein is rapidly translocated from the surface of the platelet membrane and appears in the form of a solution in the blood flow. P-selectin plays a key role in the initial recruitment of leukocytes into the site of injury or inflammation. Several studies have reported inflammation as the cause of thrombosis (6).
In a case-control study conducted by Ay et al., 116 patients suffering from recurrent VTE and 129 healthy controls were investigated. The results indicated that the mean P-selectin level was higher in the case group as compared to the control group. They also found that the risk of elevated sP-selectin concentration was considerably high in patients with VTE. They observed no significant relationship between sP-selectin concentration and platelet count or BMI. Their findings also demonstrated that the increase in sP-selectin concentration played a similar or even more important role than the increase in factor VIII level, hyperhomocysteinemia, and factor V Leiden mutation in VTE (12). The findings reported in that study are consistent with the findings of the current study.
In their study, Rectenwald et al. introduced P-selectin as a new and important predictive factor for DVT (13). In another study, Smith et al. investigated three groups of participants: patients with spontaneous venous thrombosis, patients with postoperative thrombosis, and a group of healthy controls. Their findings indicated that P-selectin level was strongly correlated with thrombosis and could be used as a prognostic factor for determining the risk of thrombosis after surgery (14). The findings reported in both of these studies are in line with the findings of the present study.
In the study conducted by Bucek et al., patients with VTE did not show any significant difference from the healthy controls in terms of sP-selectin concentration (15). This finding is not in line with our findings in the current study. This inconsistency might be due to the differences in the statistical population addressed in each study as well as the duration of investigation.
According to the results obtained in the current study, P-selectin level was not associated with gestational age. In a different study, Bioso et al. assessed plasma P-selectin levels during pregnancy with the aim of determining its impact on hypertension and preeclampsia in the pregnant women. They observed that in none of the stages of pregnancy was there any significant difference between the case group and the control group as regards P-selectin level (16). Although the statistical population of their study was different from ours, the findings of the two studies are consistent.