Patients with persistent APC-resistance without factor V Leiden mutation.
BACKGROUND
Activated protein C (APC) resistance and factor V Leiden mutation are major risk factors for deep venous thrombosis. Previous work has led to the view that the coagulation phenotype and the genetic defect are associated in almost all patients. It has been reported about single APC-resistant patients without associated factor V Leiden, but significance and thrombotic risk of this constellation have not yet been established.


METHODS
We tested 486 consecutive patients with deep venous thrombosis, arterial disease or other than vascular disease for APC-resistance with a factor VIII based assay.


RESULTS
149 patients (31%) showed a pathological APC-ratio. Sensitivity and specificity for detection of factor V Leiden were 100% and 40%, respectively. At 6 months follow-up APC-ratio returned to normal in 55% of the patients with initial pathological APC-resistance. At 12 months follow-up 91% of the patients with persistent APC-resistance showed a pathological ratio as well.


CONCLUSIONS
Patients with APC-resistance not due to factor V Leiden can be attributed to one subset with reversible APC-resistance--possibly due to a hypercoagulable state in an acute thrombotic situation, and to another with persistent APC-resistance.
Department of Internal Medicine, University of Dresden, Germany.
T
T
Schwarz
G
G
Siegert
U
U
Mikulin
S
S
Gehrisch
E
E
Runge
L P
LP
Berg
R
R
Koch
S M
SM
Schellong
D020016:Activated Protein C Resistance / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006455:Hemoglobins, Abnormal / Q000235:genetics*; D006801:Humans; D009154:Mutation / Q000235:genetics*; D012306:Risk; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000235:genetics*
D006455:Hemoglobins, Abnormal; C029445:hemoglobin Leiden