Tissue factor pathway inhibitor and the risk of recurrent venous thromboembolism

Matthias Hoke; Paul A. Kyrle; Erich Minar; Christine Bialonzcyk; Mirko Hirschl; Barbara Schneider; Marietta Kollars; Ansgar Weltermann; Sabine Eichinger

doi:10.1160/TH05-06-0412

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 94(04): 787-790
DOI: 10.1160/TH05-06-0412

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Tissue factor pathway inhibitor and the risk of recurrent venous thromboembolism

Authors

Matthias Hoke

¹Department of Internal Medicine I, Div. of Hematology/Hemostasis, Medical University of Vienna, Vienna, Austria
Paul A. Kyrle

¹Department of Internal Medicine I, Div. of Hematology/Hemostasis, Medical University of Vienna, Vienna, Austria
Erich Minar

²Department of Internal Medicine II, Div. of Angiology, Medical University of Vienna, Vienna, Austria
Christine Bialonzcyk

³Wilhelminenspital, Department of Dermatology, Vienna, Austria
Mirko Hirschl

⁴Hanuschkrankenhaus, Department of Angiology, Vienna, Austria
Barbara Schneider

⁵Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
Marietta Kollars

¹Department of Internal Medicine I, Div. of Hematology/Hemostasis, Medical University of Vienna, Vienna, Austria
Ansgar Weltermann

¹Department of Internal Medicine I, Div. of Hematology/Hemostasis, Medical University of Vienna, Vienna, Austria
Sabine Eichinger

¹Department of Internal Medicine I, Div. of Hematology/Hemostasis, Medical University of Vienna, Vienna, Austria

Abstract

Summary

Tissue factor pathway inhibitor (TFPI) regulates factor X activation. LowTFPI is a risk factor for a first venous thrombosis. We evaluated whether low TFPI confers an increased risk of recurrent venous thromboembolism (VTE). TFPI–free antigen was measured in 611 patients with a first spontaneousVTE, and who were prospectively followed after withdrawal of anticoagulation. The endpoint was symptomatic recurrent VTE. The relative risk (RR) of recurrence increased from 1.0 (95% CI 0.4–2.6) in patients with TFPI levels ≤ 5^th percentile to 2.7 (95% CI 1.0–7.4) in patients with levels ≤ 2^nd percentile as compared with higher levels. At five years, the probability of recurrence was 48.6% (95^th CI 19.0–78.1) among patients with TFPI ≤ 2^nd percentile and 16.8% (95^th CI 13.8–19.8) among those with higher levels (p=0.04). Compared to patients with wild type factor V and high TFPI, the RR of recurrence was 1.1 (95% CI 0.7–1.7) in patients with factorV Leiden and high TFPI, 2.3 (95% CI 0.6–9.5) in patients with wild type factor V and low TFPI and 3.5 (95% CI 0.9–14.3) in patients with factor V Leiden and low TFPI. In a multivariate analysis, the high risk of recurrence in carriers of factor V Leiden and low TFPI slightly decreased [RR 2.8 (95% CI 0.6–9.5)]. We conclude that thrombosis patients with low levels of freeTFPI are at an increased risk of recurrent VTE.

Keywords

Tissue factor pathway inhibitor - venous thrombosis - recurrence - factor V Leiden

Full Text

References

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