Thrombin-activatable fibrinolysis inhibitor and the risk for recurrent venous thromboembolism.
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.
Eichinger
Sabine
S
Department of Internal Medicine I, University of Vienna, Vienna, Austria. sabine.eichinger@akh-wien.ac.at
Schönauer
Verena
V
Weltermann
Ansgar
A
Minar
Erich
E
Bialonczyk
Christine
C
Hirschl
Mirko
M
Schneider
Barbara
B
Quehenberger
Peter
P
Kyrle
Paul A
PA
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
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D025901:Carboxypeptidase B2