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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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C-reactive protein and venous thromboembolism: causal or casual association?

Giuseppe Lippi1 / Emmanuel J. Favaloro2 / Martina Montagnana3 / Massimo Franchini4

1U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Italy

2Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, Australia

3Sezione di Chimica Clinica, Dipartimento di Scienze della Vita e della Riproduzione, Università di Verona, Italy

4Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliero-Universitaria di Parma, Italy

Corresponding author: Prof. Giuseppe Lippi, Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Ospedale Policlinico G.B. Rossi, Piazzale Scuro, 10, Verona 37134, Italy Phone: +39-045-8126698, Fax: +39-045-8201889, ;

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 48, Issue 12, Pages 1693–1701, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2010.335, August 2010

Publication History

Published Online:


The plasma concentration of C-reactive protein (CRP), the first acute-phase protein to be identified, increases dramatically following tissue injury or inflammation. Although the physiological role of CRP is still not fully known, it has been suggested that concentrations might increase as part of the acute-phase response for facilitating non-specific immune functions, defense against bacterial pathogens, clearance of apoptotic and necrotic cells to prevent immunization against autoantigens and acceleration of the repair process. In agreement with the evidence that inflammation plays a pivotal role in the pathogenesis of atherosclerosis, CRP concentrations have been associated with cardiovascular disease, and measurement of CRP has therefore been proposed as a valuable aid to predict and stratify the risk of myocardial infarction and stroke. Recently, some clinical and biological evidence in support of the hypothesis that CRP might be also involved in the onset of venous thrombosis have emerged. Native and monomeric CRP exert several prothrombotic activities, including activation of blood coagulation, impairment of the endogenous fibrinolytic capacity, and stimulation or enhancement of platelet adhesiveness and responsiveness. Epidemiological investigations have also shown that CRP concentrations are associated with increased risk of venous thromboembolism and, even more interestingly, that statins might be effective in reducing the risk of this pathology. Although there is increasing emphasis that CRP might not only be a marker but also an active player in the development of venous thrombosis, further evidence is needed to establish which event comes first – thrombosis or inflammation.

Clin Chem Lab Med 2010;48:1693–701.

Keywords: C-reactive protein; deep vein thrombosis; pulmonary embolism; venous thromboembolism

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