title: Levels of vitamin K-dependent procoagulant and anticoagulant proteins in over-anticoagulated patients.
abstract: Coumarin anticoagulants impair the biological activity of the vitamin K-dependent procoagulant and anticoagulant proteins. There are no reports that focus on the levels of these proteins in over-anticoagulated patients. Therefore, we determined the levels of factor II, factor VII, factor IX and factor X, protein C and protein S in 25 randomly selected over-anticoagulated patients (International Normalized Ratio >/= 6.0) and in 25 matched, therapeutically anticoagulated patients with an International Normalized Ratio within the therapeutic zone. Furthermore, to study a possible effect of the cause of over-anticoagulation, coagulant levels were compared between 16 over-anticoagulated patients with fever in the preceding 2 weeks and 24 over-anticoagulated patients with stable congestive heart failure. The pattern of procoagulant level reductions in the three groups of over-anticoagulated patients was largely the same as in therapeutically anticoagulated patients: factor X was the lowest and factor IX the highest. The difference was that, in over-anticoagulated patients, factor VII was relatively low among the procoagulant factors compared with therapeutically anticoagulated patients. Protein C was lower than protein S in over-anticoagulated patients with congestive heart failure, but was similar to protein S in the other study groups. In over-anticoagulated patients with fever, the vitamin K-dependent coagulation proteins except factor X were significantly lower than in over-anticoagulated patients with congestive heart failure, especially factor VII and protein S.
authors.affiliation: Pharmaco-Epidemiology Unit, Department of Internal Medicine and Epidemiology & Biostatistics, Erasmus University Medical Center Rotterdam, The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Penning-van Beest
authors.forename: E B
authors.initials: EB
authors.lastname: Gómez García
authors.forename: F J
authors.initials: FJ
authors.lastname: van der Meer
authors.forename: E
authors.initials: E
authors.lastname: van Meegen
authors.forename: F R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: B H
authors.initials: BH
authors.lastname: Stricker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000097:blood / Q000494:pharmacology*; D019774:Blood Coagulation Factor Inhibitors / Q000032:analysis*; D001779:Blood Coagulation Factors / Q000032:analysis* / Q000187:drug effects; D016022:Case-Control Studies; D003374:Coumarins / Q000097:blood / Q000494:pharmacology; D062787:Drug Overdose; D005260:Female; D005334:Fever / Q000097:blood; D006333:Heart Failure / Q000097:blood; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014812:Vitamin K
chemical_list: D000925:Anticoagulants; D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D003374:Coumarins; D014812:Vitamin K