Predictive value for increased FXIa activity in acute venous thromboembolism.
J Thromb Haemost 2023;
21:1610-1622. [PMID:
37003466 DOI:
10.1016/j.jtha.2023.02.031]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND
Venous thromboembolism (VTE) is associated with excessive coagulation activity, which in part can be attributed to activation of the contact system. However, the knowledge regarding the impact of contact activation in acute VTE is limited.
OBJECTIVE
To unravel the involvement of contact activation in acute VTE.
METHODS
Contact activation was investigated in acute VTE patients (n=321) and population controls without history of VTE (n=300). For comparison, FXI(a) levels, activity and plasma kallikrein (PKa) activity were determined in plasma samples with an aPTT- or thrombin generation-based assay (FXI:c and CAT:FXIa, respectively) and with enzyme-linked immunosorbent assay (ELISA) for enzyme-inhibitor complexes (FXIa:alpha-1-antitrypsin(a1AT), FXIa:antithrombin(AT), FXIa:C1-inhibitor(C1-inh), PKa:C1-inh).
RESULTS
In VTE patients, higher FXI:c levels (124±37% vs. 114±28%), but lower CAT:FXIa levels were apparent. This was accompanied by increased FXIa:a1AT, FXIa:AT and PKa:C1-inh levels in patients compared with controls (312pM[238-424] vs. 203pM[144-288]; 29pM[23-38] vs. 23pM[20-30]; 1.9nM[1.2-4.7] vs 1.4nM[0.7-3.5], respectively), whereas FXIa:C1-Inh levels did not differ. Logistic regression models showed good discriminatory value for FXI:c and FXIa:a1AT (AUC=0.64[0.6/0.69] and AUC=0.73[0.69/0.77], respectively). After 2-year follow-up, 81 recurrent VTE events or deaths occurred in the patient cohort, for which the baseline levels of FXIa:a1AT and FXIa:C1-Inh had a significant prognostic value (HR per SD[95%CI] 1.26[1.10-1.45], p=0.0012 and 1.19[1.05-1.36], p=0.0082, respectively).
CONCLUSIONS
Our study revealed elevated FXI(a) levels and activity in acute VTE which was also associated with recurrent VTE suggesting an important risk contribution of FXI activation to VTE. The evidence provided by this study supports the utility of FXI(a) inhibition in the setting of acute VTE.
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