title: Tissue factor pathway inhibitor (TFPI) in disseminated intravascular coagulation: low levels of the activated factor X-TFPI complex.
abstract: Tissue factor pathway inhibitor (TFPI) fractions and coagulation markers were determined in 26 patients with disseminated intravascular coagulation (DIC). Thrombin-antithrombin complex and fibrin monomer values were markedly elevated in all patients (P < 0.01). The median TFPI activity level (2.1 nmol/l) was lower than in normal controls (2.6 nmol/l; P < 0.01). The median free TFPI level was within the normal reference range, but seven patients had levels above and nine patients had levels below normal range. The median activated factor X (FXa)-TFPI complex level in patients (0.13 nmol/l) was lower than in controls (0.18 nmol/l; P < 0.01). Only one patient had a FXa-TFPI complex level above the normal range, while eight patients had levels below. In conclusion, TFPI activity, free TFPI antigen and FXa-TFPI complex levels vary considerably in DIC. Activation of coagulation may increase TFPI levels, as reported by other workers and supported by a positive correlation between tissue factor and free TFPI in the present material. A negative correlation between fibrin monomer and free TFPI (r = -0.46, P = 0.019) might indicate that hyperactive coagulation leads to consumption of TFPI. Subnormal FXa-TFPI levels in DIC, possibly caused by consumption, may imply a reduced capacity to inactivate the triggering factor VIIa-tissue factor complex.
authors.affiliation: Haematological Research Laboratory, Aker University Hospital, Oslo, Norway.
authors.forename: N
authors.initials: N
authors.lastname: Iversen
authors.forename: F G
authors.initials: FG
authors.lastname: Strekerud
authors.forename: U
authors.initials: U
authors.lastname: Abildgaard
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000097:blood / Q000378:metabolism; D015331:Cohort Studies; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000209:etiology; D015951:Factor Xa / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D008074:Lipoproteins / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood; D011485:Protein Binding; D018805:Sepsis / Q000097:blood / Q000150:complications; D018709:Statistics, Nonparametric; D019851:Thrombophilia / Q000097:blood
chemical_list: D000925:Anticoagulants; D008074:Lipoproteins; C051928:lipoprotein-associated coagulation inhibitor; D015951:Factor Xa