Thrombosis

ulfur-containing amino acid which originates from demethylation of dietary methionine. The metabolism of HCy involves remethylation and transsulfuration pathways. The remethylation pathway requires vitamin B12, as a cofactor of methionine synthase (EC 2.1.1.13), and folates as co-enzymes. The transsulfuration pathway requires vitamin B6 (PLP) as a co-factor for cystathionine #-synthase (EC 4.2.1.22) and cystathionine-#-lyase (EC 4.4.1.1). Genetic disorders and vitamin deficiencies can lead to increased concentrations of HCy in plasma. 1-5 Elevated HCy plasma levels have been independently associated with an increased risk of atherosclerosis and thrombosis 6-8 although a causal role of HCy in cardiovascular disease has not been firmly established yet. 9,10 Fasting total HCy (FtHCy) concentration has been shown to be a function of age, gender and vitamin status in healthy subjects by several authors. 3,11-13 The methionine -load (ML) test is a measure of HCy concentrations afte

Thrombotic events during oral anticoagulant treatment: results of the inception cohort prospective collaborative ISCOAT study

The paper reports on rate and type of thrombotic events occurring during the observational, prospective, inception-cohort, multicenter ISCOAT study. 2,745 unselected, daily practice patients, consecutively referring to 34 Italian anticoagulation clinics to monitor the oral anticoagulant treatment, were included in the study from beginning of their first anticoagulant course. During a total follow-up of 2,011 patient-years of treatment 70 thrombotic events (3.5 per 100 patient years) were recorded in 67 patients: 20 fatal (1%), 39 major (1.9%) and 11 minor (0.6%). 34/70 events occurred within the first 90 days of treatment (relative risk - at multivariate analysis - of 90 = 20.6, C.I. 12.7-33.5; p or =70 y (1.62, C.I. 1.0-2.61; p or =2 = 1.88, C.I. 1.16-3.07; p 70 years and in those with cerebrovascular/peripheral arterial disease