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J Thromb Haemost. 2016 Apr;14(4):655-66. doi: 10.1111/jth.13274. Epub 2016 Mar 14.

Activated factor VII-antithrombin complex predicts mortality in patients with stable coronary artery disease: a cohort study.

Author information

1
Department of Medicine, University of Verona, Verona, Italy.
2
Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy.
3
Haemacon Ltd, Bromley, Kent, UK.

Abstract

BACKGROUND:

Plasma concentration of activated factor VII (FVIIa)-antithrombin (AT) complex has been proposed as an indicator of intravascular exposure of tissue factor.

OBJECTIVES:

The aims of this observational study were to evaluate (i) FVIIa-AT plasma concentration in subjects with or without coronary artery disease (CAD) and (ii) its association with mortality in a prospective cohort of patients with CAD.

METHODS:

FVIIa-AT levels were measured by elisa in 686 subjects with (n = 546) or without (n = 140) angiographically proven CAD. Subjects with acute coronary syndromes and those taking anticoagulant drugs at the time of enrollment were excluded. CAD patients were followed for total and cardiovascular mortality.

RESULTS:

There was no difference in FVIIa-AT levels between CAD (84.8 with 95% confidence interval [CI] 80.6-88.2 pmol L(-1) ) and CAD-free subjects (83.9 with 95% CI 76.7-92.8 pmol L(-1) ). Within the CAD population, during a 64-month median follow-up, patients with FVIIa-AT levels higher than the median value at baseline (≥ 79 pmol L(-1) ) had a two-fold greater risk of both total and cardiovascular mortality. Results were confirmed after adjustment for sex, age, the other predictors of mortality (hazard ratio for total mortality: 2.05 with 95% CI 1.22-3.45, hazard ratio for cardiovascular mortality 1.94 with 95% CI 1.01-3.73, with a slight improvement of C-statistic over traditional risk factors), FVIIa levels, drug therapy at discharge, and even patients using all the usual medications for CAD treatment. High FVIIa-AT levels also correlated with increased thrombin generation.

CONCLUSIONS:

This preliminary study suggests that plasma concentration of FVIIa-AT is a thrombophilic marker of total and cardiovascular mortality risk in patients with clinically stable CAD.

KEYWORDS:

coronary artery disease; hypercoagulability; laboratory marker; secondary prevention; tissue factor

PMID:
27061056
DOI:
10.1111/jth.13274
[Indexed for MEDLINE]
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