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Matthias Hoke, Paul A. Kyrle, Erich Minar, Christine Bialonzcyk, Mirko Hirschl, Barbara Schneider, Marietta Kollars, Ansgar Weltermann, Sabine Eichinger
Tissue factor pathway inhibitor and the risk of recurrent venous thromboembolism
Tissue factor pathway inhibitor (TFPI) regulates factor X activation. Low TFPI is a risk factor for a first venous thrombosis. We evaluated whether low TFPI confers an increased risk of recurrent venous thromboembolism (VTE). TFPIfree antigen was measured in 611 patients with a first spontaneous VTE, 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 0.42.6) in patients with TFPI levels 5th percentile to 2.7 (95% CI 1.07.4) in patients with levels 2nd percentile as compared with higher levels. At five years, the probability of recurrence was 48.6% (95th CI 19.078.1) among patients with TFPI 2nd percentile and 16.8% (95th CI 13.819.8) 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 0.71.7) in patients with factorV Leiden and high TFPI, 2.3 (95% CI 0.69.5) in patients with wild type factor V and low TFPI and 3.5 (95% CI 0.914.3) 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 0.69.5)]. We conclude that thrombosis patients with low levels of freeTFPI are at an increased risk of recurrent VTE.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 94, 10/2005
Pages: 787 - 790