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Luo Y, Li B, Li J, Zhang Y, Deng M, Hu C, Yan W, Zhou Z, Zhang G. Coagulation Factor XIII Subunit A Is a Biomarker for Curative Effects and Prognosis in Malignant Solid Tumors, Especially Non-small Cell Lung Cancer. Front Oncol 2021; 11:719085. [PMID: 34976787 PMCID: PMC8714639 DOI: 10.3389/fonc.2021.719085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background The expression of coagulant factor XIII subunit A (FXIII-A) is significantly increased in some types of cancer cells and tumor-associated macrophages (TAMs). However, few studies on plasma FXIII-A in cancer patients have been conducted and have shown contradictory results, so the relationship of plasma FXIII-A with the progression and prognosis of malignant tumors is still unknown. This study explored the association of plasma FXIII-A with a curative effect and the prognosis of patients with malignant solid tumors. Methods We monitored plasma FXIII-A before and during systemic therapy and assessed its relationship with the curative effect and prognosis of malignant solid tumors, especially non-small cell lung carcinoma (NSCLC), by propensity-adjusted, multivariable logistic regression analysis and survival curve, in a prospective study of 1147 patients with different types of malignant solid tumors. The influencing factors of plasma FXIII-A were also analyzed. Results We found that D-dimer (D2) = 1 mg/L was the inflection point for the association between FXIII-A and D2: FXIII-A was significantly negatively correlated with D2 (r = -0.39, p < 0.01) and FDP (r = -0.40, p < 0.01) in D2 > 1 mg/L but uncorrelated with D2 or FDP in D2 ≤ 1 mg/L, which provided a method to find a more realistic plasma FXIII-A level. Plasma FXIII-A was positively correlated with age, platelets, lymphocytes, monocytes and carcinoembryonic antigen (CEA). It was found for the first time that plasma FXIII-A was abnormally significantly increased (FXIII-A > 150%) in post-therapy patients, especially in NSCLC and lung metastasis patients, and the incidence of FXIII-A > 150% in lung adenocarcinoma was 16 times higher than that in lung squamous carcinoma. FXIII-A > 150% proved to be an independent risk factor for disease progression in NSCLC patients (OR=5.74, 95% CI: 1.20-27.60, p = 0.029), predicting poor efficacy. The marked decrease in plasma FXIII-A (FXIII-A < 40%) was related to coagulation disorders and poor prognosis with a short survival time (median survival time of 4 months). Conclusions Plasma FXIII-A has the potential to be a real-time biomarker with bidirectional indicator effects to assess curative effects and prognosis in malignant solid tumors, especially NSCLC.
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Affiliation(s)
- Yujiao Luo
- Department of Hematology, Section of Hemostasis and Thrombosis, Institute of Molecular Hematology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Bin Li
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Hematology, Section of Hemostasis and Thrombosis, Institute of Molecular Hematology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Yang Zhang
- Department of Oncology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Mingyang Deng
- Department of Hematology, Section of Hemostasis and Thrombosis, Institute of Molecular Hematology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Chunhong Hu
- Department of Oncology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Wenzhe Yan
- Department of Hematology, Section of Hemostasis and Thrombosis, Institute of Molecular Hematology, The Second XiangYa Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second XiangYa Hospital, Central South University, Changsha, China
- *Correspondence: Guangsen Zhang, ; Zhiguang Zhou,
| | - Guangsen Zhang
- Department of Hematology, Section of Hemostasis and Thrombosis, Institute of Molecular Hematology, The Second XiangYa Hospital, Central South University, Changsha, China
- *Correspondence: Guangsen Zhang, ; Zhiguang Zhou,
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Yazdian M, Groeben H, Ataseven B, Schneider S, Baert T, Bommert M, Traut A, Elfers-Wassenhoven A, Brüß U, Schwameis R, du Bois A, Wagner U, Harter P. The role of factor XIII in surgery for advanced stage of epithelial ovarian cancer. Arch Gynecol Obstet 2021; 305:1311-1318. [PMID: 34724570 DOI: 10.1007/s00404-021-06308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hereditary factor (F) XIII-deficiency is a known risk factor for postoperative complications, but data of acquired FXIII-deficiency in malignancies are limited. Therefore, we evaluated the role of acquired FXIII-deficiency in surgery for advanced epithelial ovarian cancer (EOC). MATERIALS AND METHODS We performed a retrospective analysis of patients with known serum FXIII status and treatment between 2011 and 2018 at our center. We defined cohorts according to FXIII with values > 75% as normal (group A), 55-75% as reduced (group B) and < 55% as low (group C). Complications were classified according to the Clavien-Dindo Classification, class III-V complications were defined as severe. RESULTS 347 patients with EOC were identified. 180 patients (51.2%) were in group A, 82 patients (23.6%) in group B, and 85 patients (24.4%) in group C. Lower levels of FXIII were associated with higher amount of ascites, FIGO IV, high grade serous histology, low albumin, and higher CA-125 levels. Regarding intraoperative variables, low FXIII was associated with longer duration of surgery, higher blood loss, higher surgical complexity score/number of bowel anastomosis and a higher probability for macroscopic residual disease. The risk of severe complications in group A was 12.2%, 24.4% in group B, and 31.8% in group C. In a multivariate model, low FXIII (OR 2.8), > 1 bowel anastomosis (OR 2.7), age-adjusted Charlson comorbidity index ≥ 4 (OR 3.6) and a longer duration of surgery (> 285 min.) were significant predictive factors for severe complications. CONCLUSION FXIII is associated with tumor and treatment burden. A low level of FXIII is associated with postoperative complications. The knowledge about the presurgical serum FXIII-level might be helpful to plan the treatment strategy.
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Affiliation(s)
- Mahtab Yazdian
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Harald Groeben
- Department of Anesthesiology, Ev. Kliniken-Essen-Mitte, Essen, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Schneider
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Thais Baert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | | | - Ulrich Brüß
- Department of Anesthesiology, Ev. Kliniken-Essen-Mitte, Essen, Germany
| | - Richard Schwameis
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, 45136, Essen, Germany.
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany.
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Factor XIII-A: An Indispensable "Factor" in Haemostasis and Wound Healing. Int J Mol Sci 2021; 22:ijms22063055. [PMID: 33802692 PMCID: PMC8002558 DOI: 10.3390/ijms22063055] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Factor XIII (FXIII) is a transglutaminase enzyme that catalyses the formation of ε-(γ-glutamyl)lysyl isopeptide bonds into protein substrates. The plasma form, FXIIIA2B2, has an established function in haemostasis, with fibrin being its principal substrate. A deficiency in FXIII manifests as a severe bleeding diathesis emphasising its crucial role in this pathway. The FXIII-A gene (F13A1) is expressed in cells of bone marrow and mesenchymal lineage. The cellular form, a homodimer of the A subunits denoted FXIII-A, was perceived to remain intracellular, due to the lack of a classical signal peptide for its release. It is now apparent that FXIII-A can be externalised from cells, by an as yet unknown mechanism. Thus, three pools of FXIII-A exist within the circulation: plasma where it circulates in complex with the inhibitory FXIII-B subunits, and the cellular form encased within platelets and monocytes/macrophages. The abundance of this transglutaminase in different forms and locations in the vasculature reflect the complex and crucial roles of this enzyme in physiological processes. Herein, we examine the significance of these pools of FXIII-A in different settings and the evidence to date to support their function in haemostasis and wound healing.
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Shirai S, Yamauchi Y, Yokote F, Sakai T, Saito Y, Sakao Y, Kawamura M. Dynamics of coagulation factor XIII activity after video-assisted thoracoscopic lobectomy for non-small cell lung cancer. J Thorac Dis 2020; 11:5382-5389. [PMID: 32030256 DOI: 10.21037/jtd.2019.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The present study was performed to investigate the perioperative dynamics of coagulation factor XIII (FXIII) in patients with non-small cell lung cancer undergoing video-assisted thoracoscopic surgery (VATS) lobectomy compared with open lobectomy. Methods Perioperative coagulation factors including FXIII were analyzed in 30 patients who underwent VATS lobectomy and 10 patients who underwent open lobectomy at Teikyo University Hospital from December 2017 to April 2019. Results Patients in the VATS lobectomy group showed higher FXIII activity on postoperative day (POD) 5 than patients in the open lobectomy group (P=0.028). The FXIII activity was significantly lower on POD3, POD5, and POD7 than that in the preoperative period and on POD1, even in patients who had undergone VATS lobectomy (P<0.001). No factors were found to affect the maintenance of FXIII in the VATS lobectomy group. Conclusion The postoperative decrease of FXIII activity differed between patients who underwent VATS lobectomy and those who underwent open lobectomy. Based on the characteristics of FXIII, the FXIII activity may be a good marker of the invasiveness of VATS lobectomy versus open lobectomy.
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Affiliation(s)
- Suguru Shirai
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Fumi Yokote
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Sakai
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Bernerth K, Schiefke I, Liebscher K, Raczynski S, Kottmann T, Teich N. Factor-XIII activity in patients with mild to moderate ulcerative colitis and active bleeding: a prospective observational study. BMC Res Notes 2018; 11:853. [PMID: 30514356 PMCID: PMC6278029 DOI: 10.1186/s13104-018-3963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Coagulation factor XIII plays a key role in fibrin clot stabilization and epithelial healing. Under chronic inflammatory conditions involving bleeding and an activation of the coagulation cascade, the FXIIIa inversely correlate with disease activity. We assumed that FXIIIa could be a predictor of severity in patients with ulcerative colitis (UC). Here, we evaluated the course of plasma activity of FXIIIa in 49 patients with mild to moderate UC and active rectal bleeding. Patients with a partial Mayo bleeding subscore > 2 were eligible to participate in our prospective observational study in an outpatient setting. FXIIIa was investigated during acute flare conditions, after bleeding had stopped and later on in quiescent UC. RESULTS Plasma activity of FXIIIa did not show any significant differences during the UC course. FXIIIa was measured below normal range < 70% in only 8 patients during the flare and increased to normal values during follow-up in 7 of these patients. Low FXIIIa during the flare was not associated with an increased bleeding activity. In patients with a mild to moderate UC flare and prolonged bleeding, FXIIIa activity is neither predictive of UC severity nor of any bleeding activity in an outpatient setting. Trial registration This non interventional, non pharmacological prospective study was not obligated to receive a unique identifying number. This trial is registered with the Ethics Committee of the State Medical Chamber of Saxony, Dresden, Germany (Clinical Trials Registry number EK-BR-03/14-1).
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Affiliation(s)
| | - Ingolf Schiefke
- Department of Gastroenterology Hepatology, Endocrinology, and Diabetology, Leipzig, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Karin Liebscher
- Institute of Transfusion Medicine and Clinical Hemostasis, Klinikum St. Georg gGmbH, Leipzig, Germany
| | | | - Tanja Kottmann
- Clinical Research Organization Dr. med Kottmann, Hamm, Germany
| | - Niels Teich
- Practice for Digestive and Metabolic Diseases, Nordstr. 21, 04105, Leipzig, Germany.
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Risk of thrombosis and mortality in inflammatory bowel disease. Clin Transl Gastroenterol 2018; 9:142. [PMID: 29618721 PMCID: PMC5886983 DOI: 10.1038/s41424-018-0013-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/12/2018] [Accepted: 01/28/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives Patients with inflammatory bowel disease have a higher risk of thrombosis, which is associated with a higher morbidity and mortality. Most data about VTE are related to hospitalized patients with active disease, but several cases happen in the outpatient setting, and are not covered by current prophylaxis recommendation. As the knowledge of VTE in outpatients is still poor, the aim of this study is to evaluate the risk, clinical data and mortality of thrombosis in patients followed in our center, comparing our findings with the current prophylaxis recommendation. Methods The medical electronic chart of 1093 inflammatory bowel disease patients and their image exams were actively searched for words related to thrombosis, followed by charts reviewed to collect information about the event and data regarding clinical settings and thrombosis profile. Results Overall, 654 Crohn’s and 439 Colitis patients were included. Thrombosis prevalence was 5.1%,and mortality rate was higher in patients who had suffered thrombosis (10.71% vs. 1.45%, OR 8.0). Half of them developed thrombosis in the outpatient setting, 52% of these had disease activity, 17% had recent hospitalization, and 10% had previous thrombosis. In 27% of cases, diagnosis was done by routine image exams, with no clinical symptoms or previous history of thrombosis. None of them had used thromboprophylaxis. However, a great majority of patients who had thrombosis during hospitalization used heparin prophylaxis. Conclusion Inflammatory bowel disease patients who develop thrombosis have an increased mortality risk. A significant proportion of the events happened in patients without a clear thromboprophylaxis recommendation or in those receiving heparin prophylaxis.
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Abstract
Objective: To provide a comprehensive literature review on roles of coagulation factor XIII (FXIII) in coagulation, wound healing, neoplasm, bone metabolism, and pregnancy. Data Sources: All articles in PubMed with key words Coagulation factor XIII, wound, leukemia, tumor, bone, and pregnancy with published date from 2001 to 2016 were included in the study. Frequently cited publications before 2000 were also included. Study Selection: We reviewed the role of FXIII in biologic processes as documented in clinical, animal, and in vitro studies. Results: FXIII, a member of the transglutaminase (TG) family, plays key roles in various biological processes. Besides its well-known function in coagulation, the cross-linking of small molecules catalyzed by FXIII has been found in studies to help promote wound healing, improve bone metabolism, and prevent miscarriages. The study has also shown that FXIII concentration level differs in the blood of patients with leukemia and solid tumors and offers promises as a diagnostic indicator. Conclusions: FXIII has many more biologic functions besides being known as coagulation factor. The TG activity of FXIII contributes to several processes, including wound healing, bone extracellular matrix stabilization, and the interaction between embryo and decidua of uterus. Further research is needed to elucidate the link between FXIII and leukemia and solid tumors.
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Affiliation(s)
- Da-Yu Shi
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Jie Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Soendergaard C, Kvist PH, Seidelin JB, Pelzer H, Nielsen OH. Systemic and intestinal levels of factor XIII-A: the impact of inflammation on expression in macrophage subtypes. J Gastroenterol 2016; 51:796-807. [PMID: 26660730 DOI: 10.1007/s00535-015-1152-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subunit A of coagulation factor XIII (FXIII-A) is important for clot stability and acts in the subsequent wound healing process. Loss of plasma FXIII-A has been reported after surgery, sepsis, and inflammatory conditions. In the intestinal mucosa, FXIII-A is expressed by macrophages and cellular FXIII-A has been associated with phagocytosis and migration of macrophages. The objective was to evaluate the consequences of intestinal inflammation on resident mucosal macrophages, focusing on the level and distribution of FXIII-A. METHODS Plasma and colonic biopsies were collected from 67 patients with ulcerative colitis and controls. Intestinal samples were stained using immunohistochemistry for FXIII-A and macrophages (CD68, CD163 and iNOS). In situ hybridization were used to assess the intestinal expression of FXIII-A. FXIII-A antigen and activity levels were measured in plasma. RESULTS Increased infiltration of CD68 positive macrophages in the inflamed mucosa coincided with increased extracellular deposited FXIII-A and decreased expression and intracellular protein levels of FXIII-A. A decreased proportion of FXIII-A/CD68/CD163 triple-positive macrophages was observed in inflamed mucosa, indicating a reduction of the M2 phenotype with consequent loss of FXIII-A. No induction of iNOS positive macrophages was observed. Stimulation of naïve monocytes with physiological concentrations of pro-inflammatory mediators negatively affected the expression of FXIII-A. Measurements in plasma confirmed the loss of both FXIII antigen and activity during active disease. CONCLUSIONS Intestinal inflammation in UC induces loss of M2 macrophages with subsequent loss of FXIII-A synthesis. The loss of cellular FXIII-A may impact migration and phagocytosis, and hence limit pathogen eradication in UC.
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Affiliation(s)
- Christoffer Soendergaard
- Department of Gastroenterology 54O3, Medical Section, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark. .,Department of Histology and Bioimaging, Novo Nordisk A/S, Maaloev, Denmark.
| | | | - Jakob Benedict Seidelin
- Department of Gastroenterology 54O3, Medical Section, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Hermann Pelzer
- Department of Research Bioanalysis, Novo Nordisk A/S, Maaloev, Denmark
| | - Ole Haagen Nielsen
- Department of Gastroenterology 54O3, Medical Section, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730, Herlev, Denmark
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Owczarek D, Cibor D, Głowacki MK, Rodacki T, Mach T. Inflammatory bowel disease: epidemiology, pathology and risk factors for hypercoagulability. World J Gastroenterol 2014; 20:53-63. [PMID: 24415858 PMCID: PMC3886032 DOI: 10.3748/wjg.v20.i1.53] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/19/2013] [Accepted: 12/05/2013] [Indexed: 02/06/2023] Open
Abstract
Hypercoagulability observed in patients with inflammatory bowel diseases (IBD) may lead to thromboembolic events (TE), which affect the venous and arterial systems alike and are an important factor in patients' morbidity and mortality. The risk of TE in IBD patients has been demonstrated to be approximately three-fold higher as compared to the general population. The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained. The most commonly listed factors include genetic and immune abnormalities, disequilibrium between procoagulant and anticoagulant factors, although recently, the role of endothelial damage as an IBD-triggering factor is underlined. Several studies report that the levels of some coagulation enzymes, including fibrinogen, factors V, VII, VIII, active factor XI, tissue factor, prothrombin fragment 1 + 2 and the thrombin-antithrombin complex, are altered in IBD patients. It has been demonstrated that there is a significant decrease of tissue plasminogen activator level, a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor, a significantly lower level of antithrombin III and tissue factor pathway inhibitor. IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies. Hyperhomocysteinemia, which is a potential risk factor for TE was also observed in some IBD patients. Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.
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