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Non‐fatal major bleeding during treatment with vitamin K antagonists: influence of soluble thrombomodulin and mutations in the propeptide of coagulation factor IX
Author(s) -
Van Der Heijden J. F.,
Rekké B.,
Hutten B. A.,
Van Der Meer F. J. M.,
Remkes M. G. H.,
Vermeulen M.,
Büller H. R.,
Reitsma P. H.
Publication year - 2004
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2004.00768.x
Subject(s) - medicine , odds ratio , thrombomodulin , coagulation , quartile , gastroenterology , confidence interval , case control study , vitamin k , factor vii , thrombosis , vitamin k antagonist , hemostasis , warfarin , thrombin , platelet , atrial fibrillation
Summary. Background and objectives : The key complication of treatment with vitamin K antagonists (VKAs) is bleeding. The major determinant of VKA‐induced bleeding is the intensity of anticoagulation. Individual patient characteristics may also influence bleeding risk. In addition, soluble thrombomodulin (s‐TM) levels and mutations in the propeptide of factor (F)IX are important candidate risk factors in this respect. Patients and methods : A matched case–control study was designed to search for risk factors that predict bleeding during VKA treatment. We selected cases that had experienced major bleeding during treatment with VKA and matched controls without bleeding complications from the databases of two Thrombosis Services. The controls were matched for indication of treatment, age, gender, type of anticoagulant used and whether or not treatment with VKA was stopped. DNA and plasma were stored of all cases and controls. Results and conclusions : In total 110 patients and 220 controls consented to participate. The results indicate that s‐TM levels, measured by ELISA, may be a risk indicator for bleeding [crude odds ratio 3.25 for the highest quartile vs. the lowest quartile (95% confidence interval 1.40, 7.51)]. Three novel mutations, determined by direct sequencing, in the gene portion encoding the propeptide of FIX were identified that do not seem to play an important role in bleeding risk during treatment with VKAs.