Impact of reduced endogenous anti-coagulation protein activity on vascular events of peripheral arterial disease.
OBJECTIVE
Aim of the study is to elucidate the prevalence and the prognosis of patients with peripheral arterial disease (PAD) who have reduced endogenous anti-coagulation protein activity.


METHODS
Ninety six patients with PAD were studied, including 45 patients with intermittent claudication and 51 with critical limb ischemia. Among them 65 patients underwent peripheral artery bypass grafting. Venous blood samples were obtained and plasma activity level of Protein C (PC), Protein S (PS), Plasminogen (PLG), Antithrombin (AT) were measured. Based on the patients' clinical database the prevalence and clinical relevance was studied.


RESULTS
In our PAD patients PC activity is reduced in 18.8%, PS activity is reduced in 16.7%, PLG activity was reduced in 15.6% and AT activity was reduced in 24.0%. The incidence of AT activity deficiency was significantly higher in patients with critical limb ischemia than patients with claudication (P<0.01). After revascularization, arterial event free rate of patients with PC or PS activity deficiency and those with PLG deficiency were significantly lower than those without during the mean follow-up period of 26+/-31 months. The incidence of thromboembolic episodes and leg amputation rate were significantly worse in patients with PC deficiency.


CONCLUSIONS
PAD patients with reduced endogenous anti-coagulation proteins show worse prognosis than those without. Surgeons must be aware of it to improve the outcome of arterial revascularization.
Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan. komai-ths@umin.net
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Komai
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Juri
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D020152:Antithrombin III Deficiency / Q000097:blood / Q000150:complications; D000991:Antithrombins / Q000172:deficiency; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D018572:Disease-Free Survival; D015536:Down-Regulation; D005260:Female; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007511:Ischemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D010958:Plasminogen / Q000172:deficiency; D015995:Prevalence; D011486:Protein C / Q000378:metabolism; D020151:Protein C Deficiency / Q000097:blood / Q000150:complications; D017293:Protein S / Q000378:metabolism; D018455:Protein S Deficiency / Q000097:blood / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D013923:Thromboembolism / Q000097:blood / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000991:Antithrombins; D015415:Biomarkers; D019774:Blood Coagulation Factor Inhibitors; D011486:Protein C; D017293:Protein S; D010958:Plasminogen