Endothelial haemostatic factors may be associated with mortality in patients on long-term anticoagulant treatment.
The aim of the present study was to test if long-term mortality could be predicted by endothelial derived haemostatic variables in a population with high morbidity due to thromboembolic disease. Plasma samples were drawn from 212 out-patients treated with oral anticoagulants, at the beginning of the study, and analyzed for mass concentration of tissue plasminogen activator (tPA) and its inhibitor (PAI-1), and von Willebrand factor. In the course of 3.8-year follow-up 45 patients died, including 38 vascular deaths. We found that all-cause mortality was significantly associated with increased levels of vWF and tPA. For vascular mortality there was a significant association with all three haemostatic variables (tPA, PAI-1, vWF). For vWF there was a 3-fold increase in total and vascular mortality in the highest quartile compared to the lowest quartile. There were 27 vascular deaths in the group of patients with a tPA-value above the median compared to 11 in those with a tPA below the median. In multivariate Cox regression analysis (including: age, sex, smoking habits, body mass index, diabetes mellitus, hypertension, tPA, PAI-1, and vWF), vWF and smoking were independently significantly associated with all-cause mortality, and tPA and age with vascular mortality. Endothelial derived haemostatic variables are predictors of total and vascular mortality in patients treated with oral anticoagulants.
Brännström
M
M
Department of Medicine, Skellefteå Hospital, Umeå, Sweden.
Jansson
J H
JH
Boman
K
K
Nilsson
T K
TK
D000925:Anticoagulants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005500:Follow-Up Studies; D006487:Hemostasis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013923:Thromboembolism / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000032:analysis*; D014841:von Willebrand Factor / Q000032:analysis*
D000925:Anticoagulants; D017395:Plasminogen Activator Inhibitor 1; D014841:von Willebrand Factor; D010959:Tissue Plasminogen Activator