title: Protein C, protein S and von Willebrand factor levels correlate with bleeding symptoms: a population-based study.
abstract: Although natural anticoagulant deficiencies are the established causes of thrombosis, their roles in bleeding are not fully studied. The objective is to correlate haemostatic factors with haemorrhagic symptoms quantified by a standardized questionnaire. Adult subjects were recruited from Bangkok and nearby provinces as part of routine health surveys/checkups. The validated MCMDM-1VWD form was used to assess their bleeding symptoms. At the same time, von Willebrand factor (VWF) activity, free protein S levels and protein C activity were measured. There were 5196 individuals. The mean age was 44.3 years (range 15-99) and 41% were male subjects. The mean bleeding score was -0.28 and 95% of subjects had scores between -2 and +2. The scores were lower in female subjects than in male subjects (-0.35 vs. -0.16, P < 0.001). Bleeding scores correlated negatively with age, VWF and protein C activities (Spearman's ρ-0.258, -0.091 and -0.098, respectively, all P < 0.001), but did not significantly correlate with protein S levels. Using multivariate analysis, female gender, VWF below 100 IU dL(-1), protein C below 100 IU dL(-1) and protein S over 150 IU dL(-1) significantly related to high (≥3) bleeding scores (adjusted odds ratio 1.95, 1.83, 1.56 and 2.84, P = 0.001, 0.001, 0.039 and 0.017, respectively). These findings may suggest interacting roles of VWF and natural anticoagulants in modifying bleeding symptoms.
authors: Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. rojnuckarinp@gmail.com
authors: P
authors: P
authors: Rojnuckarin
authors: N
authors: N
authors: Uaprasert
authors: B
authors: B
authors: Akkawat
authors: R
authors: R
authors: Settapiboon
authors: T
authors: T
authors: Nanakorn
authors: T
authors: T
authors: Intragumtornchai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006470:Hemorrhage / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011486:Protein C / Q000032:analysis*; D017293:Protein S / Q000032:analysis*; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013785:Thailand; D055815:Young Adult; D014841:von Willebrand Factor / Q000032:analysis*
chemical_list: D011486:Protein C; D017293:Protein S; D014841:von Willebrand Factor