Comparison of three activated protein C resistance tests in the risk assessment of venous thrombosis in non-carriers of the factor V Leiden mutation

Felipe Guerrero; Catherine Arnaud; Francoise Nguyen; Bernard Boneu; Pierre Sié

doi:10.1160/TH05-08-0593

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 95(04): 728-734
DOI: 10.1160/TH05-08-0593

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Comparison of three activated protein C resistance tests in the risk assessment of venous thrombosis in non-carriers of the factor V Leiden mutation

Felipe Guerrero

¹Laboratoire de Recherche sur la Thrombose, EA 2049, Laboratoire d’Hématologie, Hôpital Rangueil

,

Catherine Arnaud

²Laboratoire d’épidémiologie, Equipe «Méthodes en Recherche Clinique», CHU Toulouse;Toulouse cedex, France

,

Francoise Nguyen

¹Laboratoire de Recherche sur la Thrombose, EA 2049, Laboratoire d’Hématologie, Hôpital Rangueil

,

Bernard Boneu

¹Laboratoire de Recherche sur la Thrombose, EA 2049, Laboratoire d’Hématologie, Hôpital Rangueil

,

Pierre Sié

¹Laboratoire de Recherche sur la Thrombose, EA 2049, Laboratoire d’Hématologie, Hôpital Rangueil

› Author Affiliations

Abstract

Summary

Activated protein C resistance (APCR), measured using the original assay described by Dahlbäck, is a risk factor for venous thrombosis independent of the factor V Leiden (FVL) mutation. This assay is based on the activated partial thromboplastin time (APTT) after plasma exposure to activated protein C (APC).As this assay was sensitive to numerous interferences, new assays have been developed for FVL screening. The objectives of the study were to investigate the association of second generation assays for APCR with venous thrombosis in FVL non-carriers. One hundred ninety-seven subjects with a history of venous thrombosis and 211 controls were explored using 3 APCR assays, the original APTT-based assay (test A), an APTT-based assay with factorV depleted plasma pre-dilution (test B) and a direct factorX activation-based assay with the same pre-dilution (test C).We found that subjects with results in the lowest quartile of the APTT-based assays are at increased risk, compared to those in the highest quartile (test A Odds Ratio = 6.39; 95%CI 3.23–12.63; test B OR=2.72; 95%CI 1.50–4.94). There was no significant risk increase associated with test C results. After adjusting for FVIII levels, the ORs of tests A and B were similar (test A OR=3.22; 95%CI 1.47–7.08; test B OR=3.10; 95%CI 1.54–6.21). In conclusion, APTT-based assays, but not direct factor X activation-based assays, effectively detect the risk for venous thrombosis independent of FVL. Pre-dilution in factor V depleted plasma is an effective way to directly assess the risk independent of FVIII levels.

Keywords

Venous thrombosis - activated protein C resistance - factor V Leiden - factor VIII

Full Text

References

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