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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3773-3776.
Prepublished online as a Blood First Edition Paper on January 22, 2004; DOI 10.1182/blood-2003-10-3422.
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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Thrombin-activatable fibrinolysis inhibitor and the risk for recurrent venous thromboembolism
Sabine Eichinger,
Verena Schönauer,
Ansgar Weltermann,
Erich Minar,
Christine Bialonczyk,
Mirko Hirschl,
Barbara Schneider,
Peter Quehenberger, and
Paul A. Kyrle
From the Department of Internal Medicine I, Division of Hematology/Hemostasis, the Ludwig-Boltzmann Institute for Thrombosis Research, and the Department of Internal Medicine II, Division of Angiology, University of Vienna; the Department of Dermatology, Wilhelminenspital, Vienna; the Department of Angiology, Hanuschkrankenhaus, Vienna; the Institute of Medical Statistics, and the Clinical Institute of Chemical and Laboratory Diagnostics, University of Vienna, Austria.
The impact of fibrinolysis for predicting the risk for recurrent venous thromboembolism (VTE) is low. We prospectively followed up 600 patients with a first VTE and evaluated the thrombin-activatable fibrinolysis inhibitor (TAFI) as a risk factor for recurrence. A high TAFI level (75th or higher percentile in thrombosis patients) was associated with a 2-fold higher risk for recurrence compared with lower levels. The probability of recurrence 2 years after anticoagulation was 14.5% (95% confidence interval [CI], 8.6-20.4) among patients with high TAFI levels and 6.8% (95% CI, 4.3-9.3) among patients with lower levels (P = .006). Our data also support the concept of a linkage between fibrinolysis and the coagulation system. Patients with high TAFI levels had significantly higher levels of factors XI, VIII, and IX, and a high risk of recurrence was seen among patients with high TAFI levels and high levels of one of these factors. The relative risk (RR) for recurrence was highest among patients with high TAFI and high factor XI (RR, 2.9; 95% CI, 1.3-6.9), high factor VIII (RR, 6.5; 95% CI, 2.9-14.8), or high factor IX (RR, 2.0; 95% CI, 1.0-3.9) levels compared with patients with low levels of TAFI and one of these factors.
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