Acquired Activated Protein C Resistance Associated with Anti-Protein S Antibody as a Strong Risk Factor for DVT in Non-SLE Patients

Junzo Nojima; Hirohiko Kuratsune; Etsuji Suehisa; Tomio Kawasaki; Takashi Machii; Teruo Kitani; Yoshinori Iwatani; Yuzuru Kanakura

doi:10.1055/s-0037-1613291

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2002; 88(05): 716-722
DOI: 10.1055/s-0037-1613291

Review Article

Schattauer GmbH

Acquired Activated Protein C Resistance Associated with Anti-Protein S Antibody as a Strong Risk Factor for DVT in Non-SLE Patients

Junzo Nojima

¹Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan

²Department of Clinical Laboratory Science, School of Allied Health Sciences, Faculty of Medicine, Osaka University, Osaka, Japan

,

Hirohiko Kuratsune

³Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Etsuji Suehisa

¹Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan

,

Tomio Kawasaki

⁴Division of Vascular Surgery, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Takashi Machii

³Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Teruo Kitani

³Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Yoshinori Iwatani

²Department of Clinical Laboratory Science, School of Allied Health Sciences, Faculty of Medicine, Osaka University, Osaka, Japan

,

Yuzuru Kanakura

¹Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan

³Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

› Institutsangaben

Abstract

Summary

Anti-phospholipid (aPL) antibodies (Abs) are well known to be associated with thromboembolic events in patients with systemic lupus erythematosus (SLE). However, the clinical relevance of aPL Abs in patients without SLE (non-SLE) who have venous thromboembolism remains unclear. We evaluated 143 non-SLE patients with a first episode of clinically suspected deep vein thrombosis (DVT) by using objective tests for diagnosing DVT and laboratory tests including the activated protein C resistance (APC-R) test, the factor V Leiden test, and various aPL Abs. The prevalence of acquired APC-R, in which case there was no factor V Leiden mutation, was significantly higher in patients with DVT (15/58 cases, 25.9%, p <0.0001) than in those without DVT (3/80 cases, 3.7%), and confirmed that acquired APC-R was a strong risk factor for DVT (odds ratio [OR], 8.95; 95% confidence intervals [CI], 2.45-32.7; p <0.001). Multivariate logistic analysis revealed that the presence of LA, aCL, anti- β2-glycoprotein I, anti-prothrombin and anti-protein C Abs was not reliable as a risk factor for DVT in non-SLE patients, and that the presence of anti-protein S Abs was the most significant risk factor for DVT (OR, 5.88; 95% CI, 1.96-17.7; p <0.002). Furthermore, the presence of anti-protein S Abs was strongly associated with acquired APC-R (OR, 57.8; 95% CI, 8.53-391; p <0.0001). These results suggest that acquired APC-R may reflect functional interference by anti-protein S Abs of the protein C pathway, which action may represent an important mechanism for the development DVT in non-SLE patients.

Keywords

Acquired activated protein C resistance - anti-phospholipid antibodies - anti-protein C antibodies - anti-protein S antibodies - deep vein thrombosis

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Referenzen

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