Factor XI and recurrent venous thrombosis: an observational cohort study
Author(s): ,
Paul A. Kyrle
Affiliations:
Department of Medicine I, Medical University of Vienna, Vienna, Austria. Karl Landsteiner Institute of Clinical Thrombosis Research, Vienna, Austria
Correspondence: Paul A. Kyrle, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18‐20, 1090 Vienna, Austria|Tel.: +43 664 508 0608|E‐mail: paul.kyrle@meduniwien.ac.at
,
Lisbeth Eischer
Affiliations:
Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Hana Šinkovec
Affiliations:
Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
Sabine Eichinger
Affiliations:
Department of Medicine I, Medical University of Vienna, Vienna, Austria. Karl Landsteiner Institute of Clinical Thrombosis Research, Vienna, Austria
ISTH Academy. Kyrle P. May 1, 2019; 273605
Dr. Paul Alexander Kyrle
Dr. Paul Alexander Kyrle
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Background and objectives
Low factor XI activity (FXIa) reduces the risk of venous thromboembolism (VTE), and FXI is regarded as a potential target for anticoagulation.
Patients/methods
We studied the relationship between FXIa and VTE in 851 patients with unprovoked VTE in whom anticoagulation had been stopped.
Results
Recurrent VTE was recorded in 265 patients. The sex‐adjusted and age‐adjusted hazard ratio (HR) of recurrence was 0.94 (95% confidence interval [CI] 0.89–0.99) for each decrease of 10 IU dL in FXIa. The HRs of recurrence were 0.73 (95% CI 0.54–0.99) for patients with FXIa below the 34th percentile, and 1.05 (95% CI 0.79–1.39) for patients with FXIa between the 34th and 67th percentiles, as compared with patients with higher FXIa. The probability of recurrence was lower among patients with FXIa below the 34th percentile than in patients with higher FXIa (P = 0.029). At 10 years, the probabilities of recurrence were 31%, 43% and 41% among patients with FXIa below the 34th percentile, with FXIa between the 34th and 67th percentiles, or with higher FXIa, respectively. We found a significant sex‐adjusted and age‐adjusted linear association between D‐dimer levels, measured 3 weeks after anticoagulation, and FXIa. When patients’ age and sex are taken into account, a patient with 10 IU dL lower FXIa is expected to have a 2.79% (95% CI 0.95–4.59%) lower D‐dimer value (P = 0.003).
Conclusions
Our findings of a lower thrombosis risk and less pronounced hemostatic system activation among patients with low FXIa is in line with the concept that FXI is a promising target for anticoagulation.
Keyword(s)
cohort study, D‐dimer, factor XI, recurrence, venous thromboembolism
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