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Fibrinolytic activity and d-dimer levels in Behçet’s syndrome

S. Yurdakul¹, N. Hekim², T. Soysal³, I. Fresko¹, I. Bavunoglu⁴, F. Ozbakir¹, F. Tabak⁵, M. Melikoglu¹, V. Hamuryudan¹, H. Yazici¹

¹Behçet’s Syndrome Research Center; ³Division of Hematology and ⁴Division of Emergency, Department of Medicine; and ⁵Department of Infectious Diseases, Cerrahpasa Medical Faculty, University of Istanbul; and ²Pakize I Tarzi Laboratory, Istanbul, Turkey.

ABSTRACT
Objective
Thrombophlebitis occurs in a third of patients with Behçet’s syndrome (BS). The thrombotic tendency in BS has been studied with inconclusive results perhaps due to the inadequate numbers of patients studied during the acute phase of the thrombosis as well as the lack of appropriate diseased controls. We have studied tissue-type plasminogen activator (t-PA) and its inhibitor (PAI-1), and d-dimer levels in BS patients with and without thrombosis both in the acute and chronic phases along with suitable diseased and healthy controls.

Methods
t-PA and PAI-1 were studied by ELISA and d-dimer by semiquantitative latex agglutination slide test in 30 BS patients without deep vein thrombosis (DVT), 10 BS with acute DVT (ADVT), 25 BS with chronic DVT, 27 with ankylosing spondylitis, 26 diffuse systemic sclerosis, 15 patients with ADVT due to other causes, 10 patients with sepsis, and 23 healthy controls.

Results
The t-PA levels in BS with ADVT were significantly lower than those in patients with ADVT due to other causes (7.4 ± 6.2 vs. 13.4 ± 6.3, P = 0.027) while PAI-1 levels did not show significant differences between the groups (P = 0.60). The numbers of patients with d-dimer levels of &Mac179; 0.5 mg/ml in BS with ADVT were similar to those found in patients with ADVT due to other causes (9/10 vs. 14/14).

Conclusion
The relatively low t-PA levels point to a defect in fibrinolysis in BS. d-dimer levels are increased in the acute phase of thrombosis in BS.

Key words
Behcet's syndrome, d-dimer, fibrinolysis, thrombophlebitis, t-PA levels.

This work was supported by the Research Fund of the University of Istanbul. Project number: 1424/050052000.
Please address correspondence to: Sebahattin Yurdakul, MD, Ataköy 9. Kisim D 12 B Kapisi Daire 12, 34750 Istanbul, Turkey.
E-mail: profsyurdakul@hotmail.com