A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis

Francesco Sofi; Francesca Cesari; Rosanna Abbate; Franco Gensini; George Broze Jr; Sandra Fedi

doi:10.1160/TH09-09-0645

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 103(04): 749-756
DOI: 10.1160/TH09-09-0645

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis

Francesco Sofi

¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy

²Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence; Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

Francesca Cesari

¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy

,

Rosanna Abbate

¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy

,

Franco Gensini

¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy

²Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence; Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

,

George Broze Jr

³Division of Hematology, Washington University, St. Louis, Missouri, USA

,

Sandra Fedi

¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy

› Author Affiliations

Abstract

Summary

The relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05–4.12; p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial vascular diseases (OR 2.67, 95%CI 1.60–4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31–7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19–4.00; p=0.01). The results of this meta-analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis, pregnancy complications and venous thromboembolism.

Keywords

Protein Z - thrombosis - coagulation - meta-analysis

Full Text

References

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