Institute of Medical Sciences, Jan Kochanowski University, Kielce, Poland.
Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Eur J Clin Invest. 2024 Aug;54(8):e14196. doi: 10.1111/eci.14196. Epub 2024 Mar 11.
Elevated factor XI (FXI) has been shown to predispose to thromboembolism. We investigated whether it is associated with left ventricular thrombus (LVT) formation, its recurrence and subsequent thromboembolic events.
In 54 patients with prior LVT of unknown origin, who stopped anticoagulation and 54 controls, we determined FXI, along with plasma clot permeability (K), fibrinolysis time (CLT), endogenous thrombin potential (ETP), von Willebrand factor (vWF) and fibrinolysis proteins. During follow-up, the primary endpoint involving the recurrence of LVT a symptomatic ischemic stroke or systemic embolism was recorded.
Elevated (>120%) FXI levels were more often observed in LVT patients when compared to the control group (14 [25.9%] vs. 6 [11.1%], p = .048) in association with the presence of active FXI. FXI correlated with age (r = .406, p = .002), K (r = -.542, p < .001) and CLT (r = .406, p = .002), also after adjustment for age, but not with ETP, vWF or fibrinolysis proteins. During follow-up of 77.6 ± 18.5 months the primary endpoint occurred in 17 (31.5%) LVT patients, including 11 (20.4%) recurrent LVT, and in 4 (7.4%) controls (annual incidence rate 4.9% vs. 1.1%, respectively; p = .002). On multivariate logistic regression analysis, elevated FXI was independently associated with the primary endpoint (OR 1.18; 95% CI 1.09-1.28).
Elevated FXI in association with a prothrombotic state characterizes patients with prior LVT of unknown origin and predisposes to its recurrence and/or ischemic stroke during follow-up. It might be speculated that the measurement of FXI helps identify patients who could benefit from prolonged anticoagulation and FXI inhibitors in the future.
研究表明，因子 XI（FXI）升高易导致血栓栓塞。我们研究了 FXI 是否与左心室血栓（LVT）形成、其复发以及随后的血栓栓塞事件有关。
在 54 例先前不明原因 LVT 且已停止抗凝治疗的患者和 54 例对照者中，我们测定了 FXI 以及血浆血栓通透性（K）、纤维蛋白溶解时间（CLT）、内源性凝血酶潜能（ETP）、血管性血友病因子（vWF）和纤维蛋白溶解蛋白。在随访期间，记录了主要终点事件，即 LVT 复发、症状性缺血性卒中和全身性栓塞。
与对照组相比，LVT 患者中更常观察到 FXI 水平升高（＞120%）（14[25.9%]例比 6[11.1%]例，p=0.048），并伴有活性 FXI。FXI 与年龄（r=0.406，p=0.002）、K（r=-0.542，p<0.001）和 CLT（r=0.406，p=0.002）相关，即使在调整年龄后也具有相关性，但与 ETP、vWF 或纤维蛋白溶解蛋白不相关。在 77.6±18.5 个月的随访中，主要终点事件发生在 17 例（31.5%）LVT 患者中，包括 11 例（20.4%）LVT 复发，4 例（7.4%）对照组（年发生率分别为 4.9%和 1.1%，p=0.002）。多变量逻辑回归分析显示，升高的 FXI 与主要终点独立相关（OR 1.18；95%CI 1.09-1.28）。
先前不明原因 LVT 患者中升高的 FXI 与血栓形成前状态相关，并导致其在随访中复发和/或发生缺血性卒中。可以推测，FXI 的测量有助于确定未来可能受益于延长抗凝和 FXI 抑制剂治疗的患者。
