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C0178 CYP2C9 and VKORC1 gene polymorphisms in the healthy Russian and Buryat respondents in Transbaikalia
S178
Abstracts / Thrombosis Research 130 (2012) S100–S202
Results: A previously healthy 4-year-old girl presented 6 days following the onset of classical varicella zoster infection with an extensive purpuric rash covering both legs. The patient had leukocytosis with neutrophilia, thrombocytopenia (76.000X109/L), altered coagulation tests and DDimerN 2000 ng/ml). Initially it was treated with broad-spectrum antibiotics, IV acyclovir and free fresh plasma (FFP). The lesions spread rapidly towards the abdomen forming painful ecchymotic plaques with necrotic-bullous areas and hypovolemic shock 48 hours after. Laboratory tests showed a disseminated intravascular coagulation (actived partial thromboplastin N 180”, IQ b 10%, fibrinogen b 0.5 g/l, D-Dimer 9000 ng/ml) and Hb 7.2 g/dl. She was treated with enoxaparin (1 mg/kg/12 h) and FFP (15–20 ml/kg). Subsequent result confirmed the diagnosis, as she had a free protein S (PS) of 6.1 IU/dl, total PS antigen 26.4 IU/dl and positive anti-PS antibodies (IgG 138 U/ml and IgM 28 IU/ml). After 22 days treatment, the girl had functional PS levels of 34%, with skin necrosis extended to 25% of the body surface. The patient required periodic surgery to remove necrotic tissue and skin graft. After 2 months of onset of treatment, the rate of PS reached normal levels (144%), with negative anti-PS antibodies. The patient required rehabilitation therapy to improve joint mobility and muscle mass in the lower extremities. At present, the functional recovery is complete. Comment: Purpura Fulminans secondary to varicella infection, mediated by antibodies against PS, is a rare entity. The severity and the extent of it will depend on the speed of the diagnosis and therapy. The clinical picture of PF is so characteristic that it is by itself diagnostic and should be suspected in any child with a rapidly progressive purpura and antecedents of chickenpox.FFP performance in terms of increased levels of PS, can be decreased by the presence of anti-PS antibodies. Treatment should be maintained until the disappearance of the anti-PS antibodies. doi:10.1016/j.thromres.2012.08.201
C0168 The APCR ratio is differently influenced by warfarin therapy when different assays are used Petr Kessler1, Hynek Poul1, Arnost Komarek2, Maria Kusnierova1, Michaela Harudova1 1 Hospital PelhrimovHematology and Transfusion Medicine - Slovanskeho Bratrstvi 710, Pelhrimov, Czech Republic; 2Charles University in Prague, Faculty of Mathematics and PhysicsDepartment of Probability and Mathematical Statistics - Ke Karlovu 2027/3 128 00 Praha 2, Czech Republic Background: The classic test for determination of APC resistance (APCR) is based on the prolongation of the APTT after addition of activated protein C. The test predictability for the presence of factor V Leiden is improved by pre-dilution of the sample plasma with f. V deficient plasma. The ProC Ac R is an innovative assay based on the prolongation of the RVVT after the incubation with the snake venom Protac, which is an activator of endogenous protein C. Aims of the study: 1. To detect the differences between the APCR ratio values before and after termination of warfarin therapy using three different APCR assays. 2. To calculate the correlations of APCR ratio values in patients on warfarin to the presence of factor V Leiden, INR, protein C, protein S, factor VIII, and age. Methods: Patients: 90 patients taking warfarin, in whom the termination of therapy was scheduled; 10 of them were heterozygous carriers of factor V Leiden. The blood samples were obtained before and 6 weeks after termination of warfarin. Methods: The APCR was determined using the Coatest APC Resistance (Chromogenix), Coatest APC Resistance V S (Chromogenix) and ProC AC R assay (Siemens); the results were expressed as the ratio.
Protein C was determined using clotting-based and chromogenic assays, protein S activity was determined with clotting-based assay and free protein S concentration was measured by ELISA. Factor VIII activity was determined using clotting-based and chromogenic assays. Results: The APCR ratio during the warfarin therapy was significantly higher using the Coatest APCR assay (P b 0.001), not significantly different using the Coatest APCR VS assay and significantly lower using the ProC AC R assay (P b 0.001) than the APCR ratio after termination of warfarin. The APCR ratio in patients on warfarin was dependent (using multivariate analysis) on the INR value (P b 0.001) and on the presence of f. V Leiden (P = 0.018) using Coatest APCR assay, on the f. V Leiden (P b 0.001) and protein S activity (P = 0.002) and free protein S (P = 0.045) using Coatest APCR VS assay, and on the f. V Leiden (P b 0.001), protein C activity (clotting assay P = 0.008, chromogenic assay P = 0.009) using the ProC AC R assay. Comment: The APCR ratio is differently influenced by warfarin therapy, when different assays are used. The differences are probably caused mainly by different assay sensitivity to reduced protein C activity during the warfarin therapy; the addition of activated protein C in the classic test overcomes the protein C deficiency induced by warfarin, while the endogenous protein C is activated by snake venom Protac in the ProC AC R assay.
doi:10.1016/j.thromres.2012.08.202
C0178 CYP2C9 and VKORC1 gene polymorphisms in the healthy Russian and Buryat respondents in Transbaikalia Olga Stepanova, Marine Avetisyan, Yuri Vitkovsky Chita State Medical Academy, Department of Physiology - Gorky Street 39-A, Chita, Russia Background: It is now widely studied the prevalence of polymorphisms of genes CYP2C9 and VKORC1 among the Russian population, as they play an important role in warfarin therapy in patients with chronic atrial fibrillation. According to the literature the incidence of CYP2C9*2 (Ile359Leu) -11% in the Russian population, which corresponds to that of the European. As a result of genotyping studies conducted in the Moscow regionVKORC1 (polymorphic marker G3730A) genotype GG was detected in 31% of respondens, the genotype GA - 55%, and genotype AA - 14% of people. In our study, was first studied the prevalence of polymorphisms of these genes among the respondents of the Russian and Buryat in Transbaikalia. Methods: The study included 79 healthy respondents aged 17 to 21 years (mean 18 ± 2.8), who were divided for two groups (61 Russian subjects and 18 - Buryats. Genetic polymorphism was detected by PCR. Statistic analysis provided by z-test. Results: It was found the frequency of genotype Arg / Arg and Arg / Cys of gene CYP2C9*2 among the Russian respondents made 76.7% and 23.3% respectively. Among the respondents in the Buryat polymorphic variants of the gene distributed follows: 94% - Arg/Arg genotype and 5,9% - Arg/Cys genotype. No statistically significant difference in the frequency of genotypes among the Russian and Buryat were found. Genotype Cys /Cys was not detected in any of the studied groups. The frequency of genotype C/T, C/C, T/T of gene VCORK1 (polymorphic marker C1173T) among Russian was 29.5%, 45.9% and 24.6% respectively, which is statistically significantly different from the prevalence of these genotypes among Buryat (0%, 33.3%, and 66.7% respectively).
Abstracts / Thrombosis Research 130 (2012) S100–S202
Comment: The frequency of homozygotes for the C allele of the gene VCORK1 (polymorphic markerC1173T) was significantly higher among the representatives of Russian and it was one-third of the studied, than among the Buryats, while homozygotes for allele T at 2.7 times more common among Buryats compared with the Russian. doi:10.1016/j.thromres.2012.08.203
C0225 Digital TV and mobile devices to increase the compliance/ persistence to medicines in chronic subjects on oral anticoagulant drugs: The pilot study Giovanni Dirienzo1, Nicola Ciavarella2, Lino Renna3, Nicola Pansini4, Michele Virgilio2 1 ASL Altamura (BA) Laboratory Medicine - ALTAMURA (BA), Italy; 2 AReS Apulia RegionTTT-HTA – Bari, Italy; 3Digital SRL Conversano (BA) Biotecho SRL Molfetta (BA) – Bari, Italy; 4ASL Barigeneral Management – Bari, Italy Background: Oral Anticoagulant Treatment (OAT) is very effective and safe both with old drugs (warfarin) and with new drugs: dabigatran, rivaroxaban, apixaban. Adherence/Persistence to medicines is a major determinant of their effectiveness. No method has been established to assess compliance with the drugs. Our aim was to implement and validate multichannel transmission of laboratory data at home and/or on mobility and patient continuing education. Methods: At ASL Bari, a digital communication system-Digital Health (DH)–was tested which integrates management software of the OAT. It sends the reports to the patients in multi-modes (digital TV, mobile devices, web, sms).The experiment was focused on transmission of reports INR via digital TV. We recruited 11 subjects at Poggiorsini (BA, Italy), a town of 1,500 inhabitants 32 km from the nearest monitoring lab carrying out the determination of the INR for OAT. Patients were able to view the report on television (channel TGNorba24Telenorba) with access via a smart card and the use of the remote control. An optional use of mobile devices including iPhone and iPad for new drugs will be possible. A digital terrestrial system was available for older patients, less accustomed to the use of Personal Computer. Results: The use of the medication on platform DH was appreciated. With DH, the time between blood collection and delivery of therapeutic report (INR) was reduced from 4 to 2 hours and 48 minutes (− 30%) and discomfort for the patients have been much reduced. Management costs for the delivery of INR reports were reduced by 15% thanks to the DH platform. These results encourage us to use the same technology to verify compliance/persistence with the new drugs that are not subject to deliberate control of the laboratory. Comment: During the trial, we evaluated multiple benefits that this system of delivery of the report may have on the community, including the reduction of the transport of chronic patients. For new drugs, however, since there is no control by the laboratory, it's very important for us to identify a system compliance to the medicines in order to make taking the medication\"automatic\"according to prescription, and also to handle emergency situations. In conclusion the DH system is appreciated both for old and new drugs for ensuring OAT: ease of visualization and interpretation of transmitted data, doctor-patient interaction, reducing the “digital divide” and operating costs. doi:10.1016/j.thromres.2012.08.204
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C0335 Vitamin K antagonists treatment and endogenous thrombin potential in patients with venous thromboembolism Veronika Shmeleva, Yriy Namestnikov, Olesya Matvienko, Vitaly Soldatenkov Russian Research Institute of Hematology and Transfusion, Laboratory of Blood Coag - 2-nd Sovietskaya str, 16, St-Petersburg, Russia Background: Low intensity treatment with vitamin K antagonists (VKA) i.e. international normalized ratio (INR) 1,5-1,9 is still of interest for some patients with venous thromboembolism (VTE) in the extended-treatment phase, though the ninth edition of American College of Chest Physicians Guidelines recommend therapeutic INR range of 2,0 to 3,0. Aim of our study was to compare thrombin generation in VTE patients with stable INR of 1,5-1,9 and of 2,0-3,0. Methods: The study involved 42 patients with VTE (M/F 22/20, mean age 54,6 ± 15,8 yrs), duration of VKA 1,5-3 yrs, and 28 controls. None of the patients had recurrent VTE during the observational period. The endogenous thrombin potential (ETP) was measured directly using a fluorogenic assay (ThrombinoscopeTM, Netherlands) according to Hemker et al, both in the presence and in the absence of thrombomodulin (TM). STATISTICA 6.1 was used, data are given as mean ± SD. Results: ETP (nMmin) and peak (nM) in patients with INR 1,5-2,0 were significantly higher than in those with INR 2,0-3,0 (in the absence of TM: 642,8 ± 129,7 vs. 358,1 ± 210,4 and 118,4 ± 22,1 vs. 66,5 ± 39,2, respectively, p b 0,0001; in the presence of TM: 481,2 ± 106,8 vs.293,2 ± 167,4 and 108,1 ± 23,0 vs. 60,9 ± 37,6, p b 0,0001). Importantly, low intensity VKA patients had significantly lower ETP and peak than controls (in the absence of TM: 642,8 ± 129,7 vs. 1731,4 ± 253,6 and 118,4 ± 22,1 vs. 292,3 ± 50,0, respectively, p b 0,0001; in the presence of TM: 481,2 ± 106,8 vs. 932,9 ± 272,6 and 108,1 ± 23,0 vs. 196,2 ± 58,1 respectively, p b 0,0001). None of the patients with INR 1,5-1,9 had increased ETP, i.e. above 90th percentile measured in controls (N2061 nMmin in the presence of TM and N 1353 nMmin in the absence of TM). Comment: Our data suggest that in some clinical cases low intensity VKA in aims of reduced risk of bleeding and reduced frequency of monitoring is possible without higher risk of recurrent VTE. doi:10.1016/j.thromres.2012.08.205
C0186 Homocysteine and Lp(a) in patients with ischaemic cerebrovascular accidents Aikaterini Hasiou1, Michail Hasios2, Paraskevi Karapavlidou1, Anastasia Dimitrouli1, Ioanna Passalidou1 1 General Hospital of Kastoriahaematology Laboratory - 33, Mavriotissis St., 52100, Kastoria, Greece; 2General Hospital of Kastoriacardiology Clinic - 33, Mavriotissis ST., 52100, Kastoria, Greece Background: Introduction: Homocysteine (Hcy) produces a catastrophic cascade of chemical reactions in the endothelial cells lining the arterial wall, altering the antithrombotic properties of the endothelium to pre-thrombotic. Lp(a) is the lipoprotein linking the lipid metabolism with vascular thrombosis. The PURPOSE of our study is to examine all the ischaemic cerebrovascular accidents for Hcy and Lp(a) for a time period of approximately twenty months. Methods: Material-methods: A total of 221 subjects, 136 women (61.54%) and 85 men (38.46%) were examined.
Abstracts / Thrombosis Research 130 (2012) S100–S202
Results: A previously healthy 4-year-old girl presented 6 days following the onset of classical varicella zoster infection with an extensive purpuric rash covering both legs. The patient had leukocytosis with neutrophilia, thrombocytopenia (76.000X109/L), altered coagulation tests and DDimerN 2000 ng/ml). Initially it was treated with broad-spectrum antibiotics, IV acyclovir and free fresh plasma (FFP). The lesions spread rapidly towards the abdomen forming painful ecchymotic plaques with necrotic-bullous areas and hypovolemic shock 48 hours after. Laboratory tests showed a disseminated intravascular coagulation (actived partial thromboplastin N 180”, IQ b 10%, fibrinogen b 0.5 g/l, D-Dimer 9000 ng/ml) and Hb 7.2 g/dl. She was treated with enoxaparin (1 mg/kg/12 h) and FFP (15–20 ml/kg). Subsequent result confirmed the diagnosis, as she had a free protein S (PS) of 6.1 IU/dl, total PS antigen 26.4 IU/dl and positive anti-PS antibodies (IgG 138 U/ml and IgM 28 IU/ml). After 22 days treatment, the girl had functional PS levels of 34%, with skin necrosis extended to 25% of the body surface. The patient required periodic surgery to remove necrotic tissue and skin graft. After 2 months of onset of treatment, the rate of PS reached normal levels (144%), with negative anti-PS antibodies. The patient required rehabilitation therapy to improve joint mobility and muscle mass in the lower extremities. At present, the functional recovery is complete. Comment: Purpura Fulminans secondary to varicella infection, mediated by antibodies against PS, is a rare entity. The severity and the extent of it will depend on the speed of the diagnosis and therapy. The clinical picture of PF is so characteristic that it is by itself diagnostic and should be suspected in any child with a rapidly progressive purpura and antecedents of chickenpox.FFP performance in terms of increased levels of PS, can be decreased by the presence of anti-PS antibodies. Treatment should be maintained until the disappearance of the anti-PS antibodies. doi:10.1016/j.thromres.2012.08.201
C0168 The APCR ratio is differently influenced by warfarin therapy when different assays are used Petr Kessler1, Hynek Poul1, Arnost Komarek2, Maria Kusnierova1, Michaela Harudova1 1 Hospital PelhrimovHematology and Transfusion Medicine - Slovanskeho Bratrstvi 710, Pelhrimov, Czech Republic; 2Charles University in Prague, Faculty of Mathematics and PhysicsDepartment of Probability and Mathematical Statistics - Ke Karlovu 2027/3 128 00 Praha 2, Czech Republic Background: The classic test for determination of APC resistance (APCR) is based on the prolongation of the APTT after addition of activated protein C. The test predictability for the presence of factor V Leiden is improved by pre-dilution of the sample plasma with f. V deficient plasma. The ProC Ac R is an innovative assay based on the prolongation of the RVVT after the incubation with the snake venom Protac, which is an activator of endogenous protein C. Aims of the study: 1. To detect the differences between the APCR ratio values before and after termination of warfarin therapy using three different APCR assays. 2. To calculate the correlations of APCR ratio values in patients on warfarin to the presence of factor V Leiden, INR, protein C, protein S, factor VIII, and age. Methods: Patients: 90 patients taking warfarin, in whom the termination of therapy was scheduled; 10 of them were heterozygous carriers of factor V Leiden. The blood samples were obtained before and 6 weeks after termination of warfarin. Methods: The APCR was determined using the Coatest APC Resistance (Chromogenix), Coatest APC Resistance V S (Chromogenix) and ProC AC R assay (Siemens); the results were expressed as the ratio.
Protein C was determined using clotting-based and chromogenic assays, protein S activity was determined with clotting-based assay and free protein S concentration was measured by ELISA. Factor VIII activity was determined using clotting-based and chromogenic assays. Results: The APCR ratio during the warfarin therapy was significantly higher using the Coatest APCR assay (P b 0.001), not significantly different using the Coatest APCR VS assay and significantly lower using the ProC AC R assay (P b 0.001) than the APCR ratio after termination of warfarin. The APCR ratio in patients on warfarin was dependent (using multivariate analysis) on the INR value (P b 0.001) and on the presence of f. V Leiden (P = 0.018) using Coatest APCR assay, on the f. V Leiden (P b 0.001) and protein S activity (P = 0.002) and free protein S (P = 0.045) using Coatest APCR VS assay, and on the f. V Leiden (P b 0.001), protein C activity (clotting assay P = 0.008, chromogenic assay P = 0.009) using the ProC AC R assay. Comment: The APCR ratio is differently influenced by warfarin therapy, when different assays are used. The differences are probably caused mainly by different assay sensitivity to reduced protein C activity during the warfarin therapy; the addition of activated protein C in the classic test overcomes the protein C deficiency induced by warfarin, while the endogenous protein C is activated by snake venom Protac in the ProC AC R assay.
doi:10.1016/j.thromres.2012.08.202
C0178 CYP2C9 and VKORC1 gene polymorphisms in the healthy Russian and Buryat respondents in Transbaikalia Olga Stepanova, Marine Avetisyan, Yuri Vitkovsky Chita State Medical Academy, Department of Physiology - Gorky Street 39-A, Chita, Russia Background: It is now widely studied the prevalence of polymorphisms of genes CYP2C9 and VKORC1 among the Russian population, as they play an important role in warfarin therapy in patients with chronic atrial fibrillation. According to the literature the incidence of CYP2C9*2 (Ile359Leu) -11% in the Russian population, which corresponds to that of the European. As a result of genotyping studies conducted in the Moscow regionVKORC1 (polymorphic marker G3730A) genotype GG was detected in 31% of respondens, the genotype GA - 55%, and genotype AA - 14% of people. In our study, was first studied the prevalence of polymorphisms of these genes among the respondents of the Russian and Buryat in Transbaikalia. Methods: The study included 79 healthy respondents aged 17 to 21 years (mean 18 ± 2.8), who were divided for two groups (61 Russian subjects and 18 - Buryats. Genetic polymorphism was detected by PCR. Statistic analysis provided by z-test. Results: It was found the frequency of genotype Arg / Arg and Arg / Cys of gene CYP2C9*2 among the Russian respondents made 76.7% and 23.3% respectively. Among the respondents in the Buryat polymorphic variants of the gene distributed follows: 94% - Arg/Arg genotype and 5,9% - Arg/Cys genotype. No statistically significant difference in the frequency of genotypes among the Russian and Buryat were found. Genotype Cys /Cys was not detected in any of the studied groups. The frequency of genotype C/T, C/C, T/T of gene VCORK1 (polymorphic marker C1173T) among Russian was 29.5%, 45.9% and 24.6% respectively, which is statistically significantly different from the prevalence of these genotypes among Buryat (0%, 33.3%, and 66.7% respectively).
Abstracts / Thrombosis Research 130 (2012) S100–S202
Comment: The frequency of homozygotes for the C allele of the gene VCORK1 (polymorphic markerC1173T) was significantly higher among the representatives of Russian and it was one-third of the studied, than among the Buryats, while homozygotes for allele T at 2.7 times more common among Buryats compared with the Russian. doi:10.1016/j.thromres.2012.08.203
C0225 Digital TV and mobile devices to increase the compliance/ persistence to medicines in chronic subjects on oral anticoagulant drugs: The pilot study Giovanni Dirienzo1, Nicola Ciavarella2, Lino Renna3, Nicola Pansini4, Michele Virgilio2 1 ASL Altamura (BA) Laboratory Medicine - ALTAMURA (BA), Italy; 2 AReS Apulia RegionTTT-HTA – Bari, Italy; 3Digital SRL Conversano (BA) Biotecho SRL Molfetta (BA) – Bari, Italy; 4ASL Barigeneral Management – Bari, Italy Background: Oral Anticoagulant Treatment (OAT) is very effective and safe both with old drugs (warfarin) and with new drugs: dabigatran, rivaroxaban, apixaban. Adherence/Persistence to medicines is a major determinant of their effectiveness. No method has been established to assess compliance with the drugs. Our aim was to implement and validate multichannel transmission of laboratory data at home and/or on mobility and patient continuing education. Methods: At ASL Bari, a digital communication system-Digital Health (DH)–was tested which integrates management software of the OAT. It sends the reports to the patients in multi-modes (digital TV, mobile devices, web, sms).The experiment was focused on transmission of reports INR via digital TV. We recruited 11 subjects at Poggiorsini (BA, Italy), a town of 1,500 inhabitants 32 km from the nearest monitoring lab carrying out the determination of the INR for OAT. Patients were able to view the report on television (channel TGNorba24Telenorba) with access via a smart card and the use of the remote control. An optional use of mobile devices including iPhone and iPad for new drugs will be possible. A digital terrestrial system was available for older patients, less accustomed to the use of Personal Computer. Results: The use of the medication on platform DH was appreciated. With DH, the time between blood collection and delivery of therapeutic report (INR) was reduced from 4 to 2 hours and 48 minutes (− 30%) and discomfort for the patients have been much reduced. Management costs for the delivery of INR reports were reduced by 15% thanks to the DH platform. These results encourage us to use the same technology to verify compliance/persistence with the new drugs that are not subject to deliberate control of the laboratory. Comment: During the trial, we evaluated multiple benefits that this system of delivery of the report may have on the community, including the reduction of the transport of chronic patients. For new drugs, however, since there is no control by the laboratory, it's very important for us to identify a system compliance to the medicines in order to make taking the medication\"automatic\"according to prescription, and also to handle emergency situations. In conclusion the DH system is appreciated both for old and new drugs for ensuring OAT: ease of visualization and interpretation of transmitted data, doctor-patient interaction, reducing the “digital divide” and operating costs. doi:10.1016/j.thromres.2012.08.204
S179
C0335 Vitamin K antagonists treatment and endogenous thrombin potential in patients with venous thromboembolism Veronika Shmeleva, Yriy Namestnikov, Olesya Matvienko, Vitaly Soldatenkov Russian Research Institute of Hematology and Transfusion, Laboratory of Blood Coag - 2-nd Sovietskaya str, 16, St-Petersburg, Russia Background: Low intensity treatment with vitamin K antagonists (VKA) i.e. international normalized ratio (INR) 1,5-1,9 is still of interest for some patients with venous thromboembolism (VTE) in the extended-treatment phase, though the ninth edition of American College of Chest Physicians Guidelines recommend therapeutic INR range of 2,0 to 3,0. Aim of our study was to compare thrombin generation in VTE patients with stable INR of 1,5-1,9 and of 2,0-3,0. Methods: The study involved 42 patients with VTE (M/F 22/20, mean age 54,6 ± 15,8 yrs), duration of VKA 1,5-3 yrs, and 28 controls. None of the patients had recurrent VTE during the observational period. The endogenous thrombin potential (ETP) was measured directly using a fluorogenic assay (ThrombinoscopeTM, Netherlands) according to Hemker et al, both in the presence and in the absence of thrombomodulin (TM). STATISTICA 6.1 was used, data are given as mean ± SD. Results: ETP (nMmin) and peak (nM) in patients with INR 1,5-2,0 were significantly higher than in those with INR 2,0-3,0 (in the absence of TM: 642,8 ± 129,7 vs. 358,1 ± 210,4 and 118,4 ± 22,1 vs. 66,5 ± 39,2, respectively, p b 0,0001; in the presence of TM: 481,2 ± 106,8 vs.293,2 ± 167,4 and 108,1 ± 23,0 vs. 60,9 ± 37,6, p b 0,0001). Importantly, low intensity VKA patients had significantly lower ETP and peak than controls (in the absence of TM: 642,8 ± 129,7 vs. 1731,4 ± 253,6 and 118,4 ± 22,1 vs. 292,3 ± 50,0, respectively, p b 0,0001; in the presence of TM: 481,2 ± 106,8 vs. 932,9 ± 272,6 and 108,1 ± 23,0 vs. 196,2 ± 58,1 respectively, p b 0,0001). None of the patients with INR 1,5-1,9 had increased ETP, i.e. above 90th percentile measured in controls (N2061 nMmin in the presence of TM and N 1353 nMmin in the absence of TM). Comment: Our data suggest that in some clinical cases low intensity VKA in aims of reduced risk of bleeding and reduced frequency of monitoring is possible without higher risk of recurrent VTE. doi:10.1016/j.thromres.2012.08.205
C0186 Homocysteine and Lp(a) in patients with ischaemic cerebrovascular accidents Aikaterini Hasiou1, Michail Hasios2, Paraskevi Karapavlidou1, Anastasia Dimitrouli1, Ioanna Passalidou1 1 General Hospital of Kastoriahaematology Laboratory - 33, Mavriotissis St., 52100, Kastoria, Greece; 2General Hospital of Kastoriacardiology Clinic - 33, Mavriotissis ST., 52100, Kastoria, Greece Background: Introduction: Homocysteine (Hcy) produces a catastrophic cascade of chemical reactions in the endothelial cells lining the arterial wall, altering the antithrombotic properties of the endothelium to pre-thrombotic. Lp(a) is the lipoprotein linking the lipid metabolism with vascular thrombosis. The PURPOSE of our study is to examine all the ischaemic cerebrovascular accidents for Hcy and Lp(a) for a time period of approximately twenty months. Methods: Material-methods: A total of 221 subjects, 136 women (61.54%) and 85 men (38.46%) were examined.