High levels of factor VIII and risk of extra-hepatic portal vein obstruction.
OBJECTIVE
High levels of coagulation factor VIII are a risk factor for lower-limb deep vein thrombosis (DVT). Their role in extra-hepatic portal vein obstruction (EHPVO) is not established.


METHODS
Factor VIII was measured in 85 patients with EHPVO (primary in 58 and complicating liver cirrhosis in 27), in 200 with lower-limb DVT, in 108 with liver cirrhosis without thrombosis and in 200 healthy controls.


RESULTS
Factor VIII levels were significantly higher in patients with primary EHPVO (138 IU/dL, range 86-366), EHPVO and cirrhosis (147 IU/dL, 95-242), lower-limb DVT (140 IU/dL, 64-400) and cirrhosis alone (160 IU/dL, 43-446) than in controls (112 IU/dL, 62-250, p<0.001). When factor VIII exceeded 129 IU/dL (66th percentile), the odds ratios were 10.5 (95%CI 3.3-33.4) for primary EHPVO, 6.0 (1.2-30.7) for EHPVO and cirrhosis, 5.0 (2.6-9.4) for lower-limb DVT. After exclusion of the effect of the acute phase reaction, the odds ratio for primary EHPVO was 4.2 (0.8-22.7), and was 8.7 (0.9-80.5) after exclusion also of patients with chronic myeloproliferative disorders.


CONCLUSIONS
High factor VIII levels are independently associated with an increased risk for EHPVO. The risk of EHPVO increased with increasing factor VIII levels and was only partially dependent on the acute phase reaction.
Martinelli
Ida
I
Department of Internal Medicine and Medical Specialties, A. Bianchi Bonomi Hemophilia and Thrombosis Center and Gastroenterology Unit, University of Milan and IRCCS Maggiore Hospital, Milan, Italy. martin@policlinico.mi.it
Primignani
Massimo
M
Aghemo
Alessio
A
Reati
Raffaella
R
Bucciarelli
Paolo
P
Fabris
Federica
F
Battaglioli
Tullia
T
Dell'Era
Alessandra
A
Mannucci
Pier Mannuccio
PM
D000210:Acute-Phase Reaction / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult
D015415:Biomarkers; D005169:Factor VIII