Background: Our previous study showed that low (<90%) thrombin activatable fibrinolysis inhibitor (TAFI) level was the independent predictor of the deep veins total clot lysis and bleedings in a target international normalized ratio (INR) in venous thromboembolism (VTE) pts during long-term warfarin (W) therapy. The influence of TAFI level on the risk of VTE recurrences is not yet clear, but it may be assumed that high TAFI level increased this risk.

Aims: To study the TAFI level effect on the risk of VTE recurrences during the long-term W therapy.

Methods: Ninety-eight VTE pts (70 men) aged 18-76 (mean 54 ± 14) years were included in the study. Pts received unfractionated or low-weight-molecular heparin for at least 5 days followed by long-term W therapy (target INR 2,0-3,0). TAFI level was measured once during the first month of W therapy. The follow-up period was 18 months. Endpoints were VTE recurrences.

Results: TAFI level ranged from 50 to 217% (median 106%, IQR 90 to 133%). TAFI level >106% was defined as high, TAFI level ≤106% was defined as low. Median of follow-up period was 18,00 (IQR 16,95 to 18,10) months. During 18 months of W therapy, the rate of VTE recurrences was 16,3%. Kaplan-Meier analysis showed that pts with high TAFI level had higher cumulative risk of VTE recurrences (chi-square = 5,05; p=0,025). Cox regression with age and sex adjustments confirmed that high TAFI level was associated with a 3,4-fold increase in the risk of VTE recurrences during 18 months of W therapy (HR 3,39; 95% CI 1,09 to 10,53; p=0,034) compared with low TAFI level pts.

Conclusions: During 18 months of W therapy, the rate of VTE recurrences was 16,3% or 10,9% per year. High (>106%) TAFI level had a prognostic value and was associated with the 3,4-fold increase in the risk of VTE recurrences.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/high-tafi-level-as-a-predictor-of-vte-recurrences-during-long-term-warfarin-therapy/