HIGH-CONCENTRATION OF THROMBOMODULIN IN PLASMA IS ASSOCIATED WITH HEMORRHAGE - A PROSPECTIVE-STUDY IN PATIENTS RECEIVING LONG-TERM ANTICOAGULANT TREATMENT

Background The aim of this study was to prospectively test whether the risk of bleeding complications in 212 consecutive outpatients treated with oral anticoagulants could be predicted by levels of endothelium- derived hemostatic variables. Methods and Results All bleeding complic ations were recorded during 5 years of follow-up: serious bleeding was defined as intracranial bleeding or hemorrhage causing death or neces sitating hospitalization. The relationships of bleeding complications and plasma concentrations of tissue plasminogen activator, von Willebr and factor, and thrombomodulin, plasminogen activator inhibitor activi ty, and other possible risk factors were studied. Twenty-two patients suffered from bleeding complications during anticoagulant treatment; i n 14 patients, these were serious. We found that the numbers both of s erious hemorrhages and of total hemorrhages were significantly associa ted with increased levels of thrombomodulin. The number of bleeding ep isodes increased exponentially through quartiles one to four of the th romhomodulin distribution, Conclusions Thrombomodulin concentrations i n plasma are related to the risk of hemorrhage in patients treated wit h oral anticoagulants.