High concentration of thrombomodulin in plasma is associated with hemorrhage - A prospective study in patients receiving long-term anticoagulant treatment

Background The aim of this study was to prospectively test whether the risk of bleeding complications in 212 consecutive outpatients treated with oral anticoagulants could be predicted by levels of endothelium-derived hemostatic variables. Methods and Results All bleeding complications were recorded during 5 years of follow-up: serious bleeding was defined as intracranial bleeding or hemorrhage causing death or necessitating hospitalization. The relationships of bleeding complications and plasma concentrations of tissue plasminogen activator, von Willebrand factor, and thrombomodulin, plasminogen activator inhibitor activity, and other possible risk factors were studied. Twenty-two patients suffered from bleeding complications during anticoagulant treatment; in 14 patients, these were serious. We found that the numbers both of serious hemorrhages and of total hemorrhages were significantly associated with increased levels of thrombomodulin. The number of bleeding episodes increased exponentially through quartiles one to four of the thromhomodulin distribution, Conclusions Thrombomodulin concentrations in plasma are related to the risk of hemorrhage in patients treated with oral anticoagulants.