Circulation, Vol 85, 1822-1827, Copyright © 1992 by American Heart Association
PM Ridker, DE Vaughan, MJ Stampfer, JE Manson, C Shen, LM Newcomer, SZ Goldhaber and CH Hennekens
BACKGROUND. Although isolated abnormalities of plasminogen activation and
inhibition have been reported among selected patients with venous
thrombosis, it is unclear whether these deficiencies of fibrinolysis are
important risk factors for thromboembolic disease. METHODS AND RESULTS. To
evaluate whether baseline levels of endogenous tissue-type plasminogen
activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) predict
the future occurrence of venous thrombosis, levels of these proteins were
measured in prospectively collected plasma samples from 55 participants in
the Physicians' Health Study who later developed deep venous thrombosis or
pulmonary embolism and from an equal number of age- and smoking-matched
control subjects who remained free of vascular disease during a mean
follow-up period of 60.2 months. Overall, there were no statistically
significant differences between case patients and control subjects in
baseline levels of PAI-1 (50.5 versus 59.5 ng/ml, p = 0.26), t-PA (13.4
versus 13.3 ng/ml, p = 0.94), or PAI-1:t-PA ratio (6.84 versus 6.58, p =
0.82). No evidence of a threshold effect or trend was seen when these data
were analyzed by increasing quartiles of PAI-1 (p = 0.73), t-PA (p = 0.62),
or PAI-1:t- PA ratio (p = 0.93). These results were unchanged after
multivariate analysis that simultaneously controlled for other baseline
cardiovascular risk factors. CONCLUSIONS. In contrast to previous
uncontrolled case series and smaller retrospective studies, these
prospective data provide strong evidence that baseline fibrinolytic state,
as measured by t-PA and PAI-1, does not predict the occurrence of future
venous thrombosis.
ARTICLES
Baseline fibrinolytic state and the risk of future venous thrombosis. A prospective study of endogenous tissue-type plasminogen activator and plasminogen activator inhibitor
Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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