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Blood, 15 August 2008, Vol. 112, No. 4, pp. 1085-1090.
Prepublished online as a Blood First Edition Paper on June 9, 2008; DOI 10.1182/blood-2007-11-123091.


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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY

Circulating endothelial progenitor cells and residual in vivo thromboxane biosynthesis in low-dose aspirin-treated polycythemia vera patients

Francesca Santilli1, Mario Romano1, Antonio Recchiuti1, Alfredo Dragani2, Angela Falco1, Gianfranco Lessiani1, Francesca Fioritoni2, Stefano Lattanzio1, Domenico Mattoscio1, Raimondo De Cristofaro3, Bianca Rocca1, and Giovanni Davì1,2

1 Center of Excellence on Aging, G. d'Annunzio University Foundation, Chieti; 2 Department of Hematology, Pescara Hospital, Pescara; and 3 Hemostasis Research Center, Catholic University School of Medicine, Rome, Italy

Polycythemia vera (PV) is associated with high morbidity and mortality for thrombosis. We hypothesized that in PV altered sensitivity to aspirin might be related to dysfunction of the endothelial repair and/or of the nitric oxide (NO) system. Urinary thromboxane (TX) A2 metabolite (TXM), endothelial colony-forming cells (ECFCs), plasma asymmetric dimethylarginine (ADMA) and von Willebrand factor (VWF) were measured in 37 PV patients on low-dose aspirin and 12 healthy controls. Patients showed an approximately 2-fold increase in median TXM and plasma ADMA levels (P < .001), while ECFC numbers were reduced by approximately 7-fold (P < .001) as compared with nonaspirinated control. These differences were more pronounced in patients with previous thrombosis. An 8-week course of aspirin did not affect ECFCs in 6 controls. VWF and TXM correlated directly with ADMA, and inversely with ECFCs. By multiple regression analysis, lower ECFC quartiles (beta = –0.39; SE = 0.17; P = .028) and higher VWF levels (beta = 0.338, SE = 0.002, P = .034) were independent predictors of higher TXM quartiles (R2 = 0.39). Serum TXB2, measured in 22 patients, was approximat-ly 10-fold higher than aspirin-treated controls. PV patients appear to have an unbalanced ECFC/NO axis, and an apparent altered sensitivity of platelet TXA2 production, all potentially contributing to aspirin-insensitive TXM formation. Thus, additional antithrombotic strategies may be beneficial in PV.


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