Venous thromboembolism in carriers of the Factor V Leiden mutation and in patients without known thrombophilic risk factor; prediction of recurrence and APC–PCI complex concentration and/or soluble thrombomodulin antigen and activity

• Published in: Thrombosis research Vol. 121; no. 2; pp. 145 - 151
• Main Authors: Strandberg, Karin, Svensson, Peter J, Öhlin, Ann-Kristin
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Ltd 2007; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; APC–PCI complex concentration; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Case-Control Studies; Clinical Medicine; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Factor V - genetics; Female; Follow-Up Studies; FV Leiden; Hematology, Oncology and Palliative Medicine; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mutation; Predictive Value of Tests; Prospective Studies; Protein C - analysis; Protein C Inhibitor - blood; Risk Factors; s-TM activity; s-TM antigen; Sensitivity and Specificity; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombomodulin - blood; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Venous Thromboembolism - blood; Venous Thromboembolism - genetics; VTE patients; VTE recurrence; protein C inhibitor; APC–PCI complex concentration; DVT; VTE; s-TM; s-TM activity; FV; Factor V; deep vein thrombosis; APC; venous thromboembolism; PCI; soluble thrombomodulin; s-TM antigen; VTE patients; FV Leiden; VTE recurrence; activated protein C; Human; Hypercoagulability; Factor V Leiden; Deep vein thrombosis; Cardiovascular disease; Hemopathy; Venous disease; Vascular disease; Thrombophilia; Risk factor; Venous thrombosis; Mutation; Thromboembolism; Thrombomodulin; Coagulopathy; APC-PCI complex concentration
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2007.03.020

Abstract Background The complex between activated protein C (APC) and the protein C inhibitor (PCI) is a sensitive indicator of the degree of activation of blood coagulation and higher concentrations have been measured in carriers of the FV Leiden mutation who were in the recovery phase after treatment for venous thromboembolism (VTE). Objectives The main purpose of this study was to correlate the APC–PCI complex concentration to thrombomodulin activity and antigen concentration in the same group of patients. We also add a prospective clinical follow-up of the VTE recurrence after 1 year to investigate if the markers can predict the risk for a new VTE. Patients/Methods Blood samples were collected from 50 patients with the FV Leiden mutation and 132 without any known risk factor for thrombophilia after finished treatment. Results The APC–PCI complex, s-TM activity and the quotient (s-TM activity) / (s-TM antigen) were higher in VTE patients with FV Leiden. In total, there were 19 VTE recurrences (10%) after 1 year. The OR for recurrence was 1.9 (95% CI 0.68–5.0) in all VTE patients with elevated APC–PCI complex (above 75th percentile) and 3.6 (95% CI 1.1–12) in VTE patients without any known risk factor for thrombophilia and with elevated s-TM activity. Conclusion The APC–PCI complex concentration, s-TM activity and the quotient (s-TM activity) / (s-TM antigen) were higher in VTE patients with FV Leiden. The s-TM activity showed higher OR for recurrence of VTE in patients without known thrombophilic risk factor. Both methods could be sensitive markers of increased risk for venous thrombosis.