title: High levels of factor VIII and risk of extra-hepatic portal vein obstruction.
abstract: 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.
authors.affiliation: 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
authors.forename: Ida
authors.initials: I
authors.lastname: Martinelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Primignani
authors.forename: Alessio
authors.initials: A
authors.lastname: Aghemo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Reati
authors.forename: Paolo
authors.initials: P
authors.lastname: Bucciarelli
authors.forename: Federica
authors.initials: F
authors.lastname: Fabris
authors.forename: Tullia
authors.initials: T
authors.lastname: Battaglioli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dell'Era
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: 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
chemical_list: D015415:Biomarkers; D005169:Factor VIII