Enhanced anticoagulant response to activated protein C in patients with IDDM.
Anticoagulant response to activated protein C (APC) was studied in 40 healthy subjects and 67 patients with insulin-dependent diabetes mellitus (IDDM) using a modified activated thromboplastin time assay. Results are expressed in terms of the APC sensitivity ratio (APC SR). In addition, plasma levels of protein C, total and free protein S (PS), coagulation factors V and VIII, and prothrombin fragment 1+2 (F1+2) were measured. Patients with IDDM and a urinary albumin excretion rate (UAER) < 30 mg/24 h showed a median APC SR of 2.5 (interquartile range 2.3-2.9). In patients with a UAER between 30 and 300 mg/24 h, the median APC SR was 2.7 (2.7-2.9). Both values were significantly greater than the median APC SR of 2.1 (2.0-2.5) observed in healthy control subjects (P < 0.001). Also, the percentage of subjects with an APC SR < or = 2.0 was markedly smaller in both patient groups. Factor V and VIII levels were not significantly different between IDDM patients and healthy subjects. Grouping of IDDM patients according to the APC SR revealed significantly enhanced levels of total PS (P < 0.05) and factor VIII (P < 0.01) in patients with a poor anticoagulant response to APC (APC SR < or = 2.0) compared with those with an APC SR > 2.7. The negative correlation of the APC SR in diabetic patients with both coagulation and anticoagulation factors indicates a complex role of this parameter in regulating the coagulation system in IDDM.
Krugluger
W
W
Department of Laboratory Medicine, Rudolfstiftung Hospital, Vienna, Austria.
Kopp
H P
HP
Schernthaner
G
G
Hopmeier
P
P
D000328:Adult; D000419:Albuminuria; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000652:urine; D003930:Diabetic Retinopathy / Q000097:blood; D005165:Factor V / Q000378:metabolism*; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000378:metabolism* / Q000494:pharmacology*; D017293:Protein S / Q000378:metabolism; D012016:Reference Values; D018709:Statistics, Nonparametric
D011486:Protein C; D017293:Protein S; D005165:Factor V; D005169:Factor VIII