PROTEIN-C DEFICIENCY IN A CONTROLLED SERIES OF UNSELECTED OUTPATIENTS - AN INFREQUENT BUT CLEAR RISK FACTOR FOR VENOUS THROMBOSIS (LEIDEN THROMBOPHILIA STUDY)

被引:311
作者
KOSTER, T
ROSENDAAL, FR
BRIET, E
VANDERMEER, FJM
COLLY, LP
TRIENEKENS, PH
POORT, SR
REITSMA, PH
VANDENBROUCKE, JP
机构
[1] UNIV LEIDEN HOSP,CTR HEMOSTASIS & THROMBOSIS RES,2300 RC LEIDEN,NETHERLANDS
[2] ANTICOAGULAT CLIN,LEIDEN,NETHERLANDS
[3] ANTICOAGULAT CLIN,AMSTERDAM,NETHERLANDS
[4] ANTICOAGULAT CLIN,ROTTERDAM,NETHERLANDS
关键词
D O I
10.1182/blood.V85.10.2756.bloodjournal85102756
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A deficiency of protein C (PC), antithrombin, or protein S is strongly associated with deep-vein thrombosis in selected patients and their families. However, the strength of the association with venous thrombosis in the general population is unknown. This study was a population-based, patient-control study of 474 consecutive outpatients, aged less than 70 years, with a first, objectively diagnosed, episode of venous thrombosis and without an underlying malignant disease, and 474 healthy controls who matched for age and sex. Relative risks were estimated as matched odds ratios. Based on a single measurement, there were 22 (4.6%) patients with a PC deficiency (PC activity, less than 0.67 U/mL or PC antigen, less than 0.33 U/mL when using coumarins). Among the controls, the frequency was 1.5% (seven subjects). Thus, there is a threefold increase in risk of thrombosis in subjects with PC levels below 0.67 or 0.33 U/mL [matched odds ratio, 3.1; 95% confidence interval (CI), 1.4 to 7.0]. When a PC deficiency was based on two repeated measurements, the relative risk for thrombosis increased to 3.8 (95% CI, 1.3 to 10); when it was based on DNA-confirmation, the relative risk increased further to 6.5 (95% CI, 1.8 to 24). In addition, there was a gradient in thrombosis risk, according to PC levels. The results for antithrombin are similar to those for PC, although less pronounced (relative risk, 2.2; 95% CI, 1.0 to 4.7). We could not find an association between reduced total protein S (relative risk, 0.7; 95% CI, 0.3 to 1.8) or free protein S levels (relative risk, 1.6; 95% CI, 0.6 to 4.0) and thrombosis risk. Although not very frequent, PC and antithrombin deficiency are clearly associated with an increase in thrombosis risk. (C) 1995 by The American Society of Hematology.
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页码:2756 / 2761
页数:6
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