Plasma levels of activated protein C protein C inhibitor complex in patients with hypercoagulable states

Plasma levels of activated protein C (APC)-protein C inhibitor (PCI) were s ignificantly increased in patients with disseminated intravascular coagulat ion (DIG), thrombotic thrombocytopenic purpura (TTP), acute myocardial infa rction (AMI), pulmonary embolism (PE), or deep vein thrombosis (DVT) and in patients undergoing hemodialysis (HD), Plasma levels of APC-alpha(1)-antit rypsin (AT) complex were significantly increased in patients with DIG and i n those with TTP, Plasma levels of PGI were significantly decreased in pati ents with DIG, non-DIG, or TTP and in those undergoing HD, In the pre-DIG s tage, the plasma levels of APC-PCI complex were significantly increased but not those of APC-alpha(1)-AT complex. These data suggest that measurements of APC-PCI complex and APC-alpha(1)-AT complex may be useful for the diagn osis of DIG. After treatment of DIC, the plasma levels of APC-PCI complex a nd APC-alpha(1)-AT complex were significantly decreased, but not those of P GI. Plasma levels of thrombin-antithrombin complex (TAT), plasmin-alpha(1)- plasmin complex (PPIC), D-dimer, and soluble fibrin monomer (SFM) were mark edly increased in patients with DIG or pre-DIG and were moderately increase d in patients with non-DIG, TTP, AMI, PE, or DVT and in those undergoing HD . The receiving operating characteristic (ROC) analysis showed that SFM and the APC-PCT complex are useful markers for diagnosis of DIG, The specifici ty of plasma TAT and PPIC levels was low. The positive rate of APC-PCI comp lex was higher than 90% with DIG, TTP, AMI, PE, and it was higher than 60% with DVT and HD. Since the APC-PCI complex was elevated not only in patient s with venous thrombosis but also in those with arterial thrombosis, compon ents of the protein C pathway might be useful markers for the diagnosis of arterial thrombosis. (C) 2000 Wiley-Liss, Inc.