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Home > Vascular Annual Meeting^® > PP47. Impact of Reduced Endogenous Anti-coagulation...

PP47. Impact of Reduced Endogenous Anti-coagulation Protein Activity on Vascular Events of Peripheral Arterial Disease

Hiroyoshi Komai1,2, Hiroshi Shigematsu1, Masanobu Juri2
1Tokyo Medical University, Shinjuku, Tokyo, Japan; 2Saiseikai Wakayama Hospital, Wakayama, Japan

OBJECTIVES: To elucidate the prevalence and the prognosis of patients with peripheral arterial disease (PAD) who have reduced endogenous anti-coagulation protein activity in the Japanese population.

METHODS: 96 patients with PAD were studied, including 45 patients with intermittent claudication and 51 with critical limb ischemia. Among them 65 patients undertook a peripheral artery bypass grafting and were followed for the mean period of 26±31 months. Venous blood samples were obtained and plasma activity level and antigen titer of Protein C (PC), Protein S (PS), Plasminogen (PLG), Antithrombin (AT) were measured. Based on the patients’ clinical database the prevalence and clinical relevance was studied.

RESULTS: Result 1: In our PAD patients PC activity is reduced in 18.8%, PS activity is reduced in 16.7%, PLG activity was reduced in 15.6% and AT activity was reduced in 24.0%. The incidence of AT activity deficiency was significantly higher in patients with critical limb ischemia than patients with claudication (p<0.01). Result 2: After revascularization, 1, 3 and 5 year event free rate of patients with PC or PS activity deficiency are 53, 30, 15%, respectively, whereas those of patients without PC and PS deficiencies are 80, 64, 38%, being significantly higher rates (p<0.05, Mantel-Cox test). Also, 1, 3 and 5 year event free rate of patients with PLG activity deficiency are 38, 0, 0%, respectively, and those of patients without PLG activity deficiency are 79, 62, 34%, being significantly higher (p<0.01, Mantel-Cox test). Result 3: The percentage of thromboembolic episodes was significantly high in patients with reduced PC activity compared with those with normal PC activity (29.4% vs. 7.6%, p<0.05). Result 4: Patients with PC activity deficiency were more susceptible to leg amputation (6 patients, 35.3% of patients with deficiency) than those without (10 patients, 12.7% of patients without deficiency) (p<0.01).

CONCLUSIONS: The PAD patients with reduced endogenous anti-coagulation proteins shows worse prognosis than those without. Surgeons must be aware of it to improve the outcome of arterial revascularization.

AUTHOR DISCLOSURES: H. Komai, None; H. Shigematsu, None; M. Juri, None.