Thrombosis and Inflammation: The Connection

The jury is in on inflammation. The verdict?

Inflammation has been found guilty of causing thrombosis in patients.

This dynamic and complex subject is being explored across the medical community. While it is well known that there is a relationship between inflammation and thrombosis, researchers are exploring when, why, and how.

The Connection

Thrombosis and inflammation have an intricate, circular relationship, where each can cause the other. In an editorial by Dr. Peter Libby and Dr. Daniel Simon, published by the American Heart Association in 2001, they wrote “Inflammation can beget local thrombosis, and thrombosis can amplify inflammation.”

This happens when the inner linings of the vascular walls become damaged, and they release micro-particles, which contain pro-inflammatory molecules that bind white blood cells together in a web-like trap called NETS (neutrophil extracellural traps).

The inner linings of the vascular walls can become damaged by inflammatory diseases such as cancer, diabetes, and obesity, and thrombosis.

What Does this Mean for Patients?

If inflammation and thrombosis are so tightly linked, what does this mean for patients?

It means that patients can take power into their own hands by reducing inflammation-causing behaviors, such smoking, eating a poor diet, and stress. It also means that patients need to be aware of inflammatory conditions and risk factors that may put them at risk for thrombosis. These factors include illnesses such as cancer, diabetes, and hypertension.

Lesser known illnesses can also put patients at risk, such as psoriasis, a chronic inflammatory skin disease.

Research around these inflammatory-related diseases has the potential to answer why thrombosis and inflammation are connected.

Consider recent research out of Case Western Reserve University[1]. The research examined psoriasis and its relation to thrombosis. Researchers were able to connect interleukin 6 (IL-6), which is linked to inflammation in psoriasis, with thrombosis. In the mice they were studying, those without IL-6 saw a lower risk of thrombosis.

Research such as this takes medical professionals one step closer to the answers they’re seeking.

Searching for Answers

While many different studies explore the pathways and connection between thrombosis and inflammation, one specific trial is looking into how the connection can be used to find a cure, the Cardiovascular Inflammation Reduction Trial (CIRT).

CIRT is testing the inflammatory hypothesis of atherothrombosis to discover if stopping inflammation will lead to lower rates of vascular health issues in patients. The goal of this trial is to test whether or not low-dose methotrexate, an anti-inflammatory therapy used to treat rheumatoid arthritis, will reduce rates of cardiovascular health issues, such as heart attack or stroke, in stable coronary artery disease patients with type 2 diabetes or metabolic syndrome, conditions tied to an enhanced pro-inflammatory response.

This trial builds upon the results of an earlier one, known as JUPITER. In that trial, low doses of rosuvastatin were given to participants with a higher risk for vascular problems based on a pro-inflammatory response. They found that participants had a 44 percent reduction in major vascular health issues and 43 percent was a reduction in DVT/PE.

Looking Forward

While CIRT is already in progress, it could be years before its outcomes are released and its impact is realized. Science and medicine will continue to forge ahead, exploring the connection between thrombosis and inflammation.

[1] Yunmei Wang, Jackelyn B. Golden, Yi Fritz, Xiufen Zhang, Doina Diaconu, Maya I. Camhi, Huiyun Gao, Sean M. Dawes, Xianying Xing, Santhi K. Ganesh, Johann E. Gudjonsson, Daniel I. Simon, Thomas S. McCormick, Nicole L. Ward. Interleukin 6 regulates psoriasiform inflammation–associated thrombosis. JCI Insight, 2016; 1 (20) DOI: 10.1172/jci.insight.89384

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