title: Thrombin-activatable fibrinolysis inhibitor and the risk for recurrent venous thromboembolism.
abstract: The impact of fibrinolysis for predicting the risk for recurrent venous thromboembolism (VTE) is low. We prospectively followed up 600 patients with a first VTE and evaluated the thrombin-activatable fibrinolysis inhibitor (TAFI) as a risk factor for recurrence. A high TAFI level (75th or higher percentile in thrombosis patients) was associated with a 2-fold higher risk for recurrence compared with lower levels. The probability of recurrence 2 years after anticoagulation was 14.5% (95% confidence interval [CI], 8.6-20.4) among patients with high TAFI levels and 6.8% (95% CI, 4.3-9.3) among patients with lower levels (P =.006). Our data also support the concept of a linkage between fibrinolysis and the coagulation system. Patients with high TAFI levels had significantly higher levels of factors XI, VIII, and IX, and a high risk of recurrence was seen among patients with high TAFI levels and high levels of one of these factors. The relative risk (RR) for recurrence was highest among patients with high TAFI and high factor XI (RR, 2.9; 95% CI, 1.3-6.9), high factor VIII (RR, 6.5; 95% CI, 2.9-14.8), or high factor IX (RR, 2.0; 95% CI, 1.0-3.9) levels compared with patients with low levels of TAFI and one of these factors.
authors.affiliation: Department of Internal Medicine I, University of Vienna, Vienna, Austria. sabine.eichinger@akh-wien.ac.at
authors.forename: Sabine
authors.initials: S
authors.lastname: Eichinger
authors.forename: Verena
authors.initials: V
authors.lastname: Schönauer
authors.forename: Ansgar
authors.initials: A
authors.lastname: Weltermann
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Christine
authors.initials: C
authors.lastname: Bialonczyk
authors.forename: Mirko
authors.initials: M
authors.lastname: Hirschl
authors.forename: Barbara
authors.initials: B
authors.lastname: Schneider
authors.forename: Peter
authors.initials: P
authors.lastname: Quehenberger
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kyrle
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000032:analysis; D025901:Carboxypeptidase B2 / Q000097:blood*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000453:epidemiology; D020246:Venous Thrombosis / Q000097:blood* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D025901:Carboxypeptidase B2