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Thromb Haemost 2015; 114(06): 1156-1164
DOI: 10.1160/TH15-01-0031
Coagulation and Fibrinolysis
Schattauer GmbH

Plasminogen activator inhibitor-1 4G/5G polymorphism, factor V Leiden, prothrombin mutations and the risk of VTE recurrence

Kristina Sundquist
1   Center for Primary Care Research, Lund University, Malmo, Sweden
2   Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
,
Xiao Wang
1   Center for Primary Care Research, Lund University, Malmo, Sweden
,
Peter J. Svensson
3   Clinical Coagulation Research Unit, Lund University, Malmo, Sweden
,
Jan Sundquist
1   Center for Primary Care Research, Lund University, Malmo, Sweden
2   Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
,
Anna Hedelius
1   Center for Primary Care Research, Lund University, Malmo, Sweden
,
Sara Larsson Lönn
1   Center for Primary Care Research, Lund University, Malmo, Sweden
,
Bengt Zöller
1   Center for Primary Care Research, Lund University, Malmo, Sweden
,
Ashfaque A. Memon
1   Center for Primary Care Research, Lund University, Malmo, Sweden
› Author Affiliations Financial support: This work was supported by the following grants: to Bengt Zöller from the Swedish Heart-Lung Foundation and The Swedish Research Council; to Kristina Sundquist from the Swedish Research Council; to Jan Sundquist, Kristina Sundquist and Bengt Zöller from ALF funding from Region Skåne.
Further Information

Publication History

Received: 12 January 2015

Accepted after major revision: 29 June 2015

Publication Date:
30 November 2017 (online)

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Summary

Plasminogen-activator inhibitor (PAI)-1 is an important inhibitor of the plasminogen/plasmin system. PAI-1 levels are influenced by the 4G/5G polymorphism in the PAI-1 promoter. We investigated the relationship between the PAI-1 polymorphism and VTE recurrence, and its possible modification by factor V Leiden (FVL) and prothrombin (PTM) mutations. Patients (n=1,069) from the Malmö Thrombophilia Study were followed from discontinuation of anticoagulant treatment until diagnosis of VTE recurrence or the end of the study (maximum follow-up 9.8 years). One hundred twenty-seven patients (11.9 %) had VTE recurrence. PAI-1 was genotyped by TaqMan PCR. Cox regression analysis adjusted for age, sex and acquired risk factors of VTE showed no evidence of an association between PAI-1 genotype and risk of VTE recurrence in the study population as a whole. However, by including an interaction term in the analysis we showed that FVL but not PTM modified the effect of PAI-1 genotype: patients with the 4G allele plus FVL had a higher risk of VTE recurrence [hazard ratio (HR) =2.3, 95 % confidence interval (CI) =1.5–3.3] compared to patients with the 4G allele but no FVL (reference group) or FVL irrespective of PAI-1 genotype (HR=1.8, 95 % CI=1.3–2.5). Compared to reference group, 5G allele irrespective of FVL was associated with lower risk of VTE recurrence only when compared with 4G allele together with FVL. In conclusion, FVL has a modifying effect on PAI-1 polymorphism in relation to risk of VTE recurrence. The role of PAI-1 polymorphism as a risk factor of recurrent VTE may be FVL dependent.

Keywords

Fibrinolysis - plasminogen - PAI-1 polymorphism - recurrence - venous thromboembolism

 

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