title: Tissue factor pathway inhibitor (TFPI) release after heparin stimulation is increased in Type 1 diabetic patients with albuminuria.
abstract: OBJECTIVE
  To study heparin-stimulated TFPI release in relation to complications in Type 1 diabetic patients.
  
  
  METHODS
  Nineteen uncomplicated Type 1 diabetic patients (group I) were compared with 18 patients with retinopathy (group II), and nine patients with retinopathy and albuminuria (group III). Blood samples were taken before (basal) and till 30 min after 5000 IU of heparin i.v. (post-heparin). TFPI activity was measured chromogenically. Von Willebrand factor, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and thrombomodulin were also measured.
  
  
  RESULTS
  Basal TFPI activity was higher in group III (121 +/- 10%) compared with group II (111 +/- 8%) or group I (110 +/- 13%) (P < 0.05), and strongly correlated with albuminuria (r = 0.66, P < 0.05). At all time points after heparin administration, TFPI activity in group III was significantly higher than in group I. TFPI activity was also higher in group III than in group II 5-30 min post-heparin. The increase in post-heparin TFPI activity, measured as the incremental area under the curve, was higher in group III compared with group I (65 +/- 7 vs. 59 +/- 4; P < 0.05). Of the other parameters, only thrombomodulin was higher in group III (44 +/- 24 vs. 26 +/- 7 (group II) and 28 +/- 9 ng/ml (group I); P < 0.01).
  
  
  CONCLUSIONS
  We conclude that basal and post-heparin TFPI activity is increased in albuminuric patients. The increase in heparin-stimulated TFPI release in patients with albuminuria is higher than in patients with retinopathy or without complications. This could be the result of altered endothelial glycosaminoglycan characteristics.
authors.affiliation: Department of Internal Medicine, University Hospital, Maastricht, The Netherlands. pleurs@soz.nl
authors.forename: P B
authors.initials: PB
authors.lastname: Leurs
authors.forename: R
authors.initials: R
authors.lastname: van Oerle
authors.forename: K
authors.initials: K
authors.lastname: Hamulyak
authors.forename: B H R
authors.initials: BH
authors.lastname: Wolffenbuttel
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008074:Lipoproteins / Q000378:metabolism*; D008297:Male; D018180:Thrombomodulin / Q000032:analysis; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D008074:Lipoproteins; D018180:Thrombomodulin; C051928:lipoprotein-associated coagulation inhibitor; D014841:von Willebrand Factor; D006493:Heparin; D010959:Tissue Plasminogen Activator