Molecular basis and thrombotic manifestations of antithrombin deficiency in 15 unrelated Chinese patients.
BACKGROUND
Antithrombin (AT) deficiency is associated with an increasing risk of thrombosis.


METHODS
15 unrelated patients with AT deficiency defined by thrombophilic assays were recruited and detailed clinical information about patients, focusing on the personal and family history of thromboembolism (TE), were recorded. Mutation analysis was performed by direct sequencing of an AT gene (SERPINC1) in the patients and their family members.


RESULTS
A total of 15 heterozygous causative mutations, each being identified in one family, were identified. Five mutations (33.3%) were reported here for the first time, including three null mutations (Ser36X, Lys70X and Try307X) and two missense mutations (Phe123Cys and Leu340Phe) probably impairing the structural integrity and stability of protein based on the AT structural analysis. Of the 15 patients, 33.3% (5/15) had additional risk factors and only one patient presented with additional genetic alteration causing an early onset of thrombosis. Fourteen patients (93.9%) suffered from multisite recurrent thrombotic episodes after a first episode of thrombosis. 93.3% of the patients experienced deep vein thrombosis (DVT) and 40.0% presented with mesenteric venous thrombosis (MVT). In addition, both venous and arterial thrombosis was present in two unrelated patients. 51.0% subjects with AT deficiency in the 15 unrelated pedigrees experienced TE events.


CONCLUSIONS
Prophylactic anticoagulation may be suggested in AT-deficient patients to avoid the recurrent and multisite thrombosis. The association of primary MVT and AT deficiency is highlighted.
Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Qiulan
Q
Ding
Min
M
Wang
Guanqun
G
Xu
Xu
X
Ye
Xiaodong
X
Xi
Tingting
T
Yu
Xuefeng
X
Wang
Hongli
H
Wang
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000737:chemistry / Q000235:genetics*; D020152:Antithrombin III Deficiency / Q000097:blood* / Q000235:genetics*; D044466:Asian People; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008958:Models, Molecular; D020125:Mutation, Missense; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000235:genetics*; D055815:Young Adult
C542513:SERPINC1 protein, human; D000990:Antithrombin III
ACA; AT; AT gene; AT:A; AT:Ag; Antithrombin; CT; DVT; ECG; FPS:A; FVIII:C; FXa; Fg; Gene mutation; HGVS; Hcy; LA; MI; MVT; PAI-1; PC:A; PC:Ag; PE; PLG; PPP; PROC; PROS; SERPINC1; TE; Thromboembolism; VTE; activated factor X; activity of antithrombin; activity of factor VIII; activity of protein C; anti-β2 glycoprotein 1; anti-β2GPI; anticardiolipin antibody; antigen of antithrombin; antigen of protein C; antithrombin; computed tomography; deep venous thrombosis; electrocardiogram; fibrinogen; free protein S activity; homocysteine; lupus anticoagulant; mesenteric venous thrombosis; myocardial infarction; plasminogen; plasminogen activator inhibitor-1; platelet poor plasma; protein C gene; protein S gene; pulmonary embolism; t-PA; the Human Genome Variation Society; thromboembolism; tissue plasminogen activator; venous thromboembolism