Presentation Details
| Elevated Protein C is Protective Against Post Thrombotic Syndrome Zijun He1, Vivian Thompson1, Dianne Thornhill1, Rick Shearer1, Christine Baird2, Marilyn Manco-Johnson1. 1University of Colorado Anschutz Medical Campus, Aurora, CO, USA.2University of Colorado Anschutz Medical Campus Research Laboratory, Aurora, CO, USA |
Abstract
Background: Genetic deficiency of protein C and S are well known risk factors for thrombosis. The impact of elevated protein C and S on thrombosis recovery in adult and pediatric patients have not yet been explored. Aims: We hypothesized that elevated levels of protein C and/or protein S would be associated with improved thrombus outcomes. Methods: This was an analysis of a consented, prospective cohort study (Thrombo-PICS) that included children, adolescents, and young adult patients who presented with arterial or venous thrombosis. We examined thrombosis outcomes among patients with elevated, normal, and decreased levels of protein C or S within three months of a thrombosis event. Outcomes included bleeding on anticoagulation, clot recurrence, clot persistence, and Post Thrombotic Syndrome (PTS) measured at least 6 months from the onset of thrombosis. Thrombophilia traits including elevated FVIII, elevated lipoprotein(a), lupus anticoagulant (LA), anticardiolipin antibodies (ACA), anti-beta-2-glycoprotein-1 antibodies (B2GP1), the factor V Leiden mutation (FVL), the prothrombin mutation (PT20210M), and antithrombin III deficiency (ATIII) were collected within three months of thrombosis event. The presence of inflammatory markers including white blood cell count (WBC), C-reactive protein (CRP), and Erythrocyte Sedimentation Rate were also measured within this time frame. Overall results were presented descriptively, and chi-squared tests were used to evaluate group differences across each adverse outcome. Results: Table 1 displays demographics and Table 2 shows thrombus outcome results. Prevalence of PTS in patients with elevated protein C at time of thrombotic event was significantly lower than those with normal or decreased protein C values (p=0.01). PTS did not significantly differ across protein S groups. There was no significant difference in the prevalence of other adverse outcomes between patients with low, normal, or high protein C or S. Elevated levels of protein C and S were inversely correlated with infection-associated thrombosis. There was a significantly higher rate of infection in the low protein C (p=0.004) and low protein S (p=0.02) groups. There was also a higher prevalence of inflammatory markers present during the acute period among patients with decreased protein C (p=0.04) as compared to those with elevated or normal levels. Conclusions: These results suggest elevated protein C levels during the acute phase of a clotting event is predictive of better PTS outcomes. Conversely, decreased levels of protein C and S were associated with higher rates of infection and inflammation and subsequently with poorer thrombus outcomes. More work is necessary to further explore thrombus outcomes relative to levels of protein C and protein S.
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