Biological VariationDiet

1
Biological Variation-Diet

• Diet
• Foods high in Vitamin K adversely affect
  warfarin, a vitamin K antagonist (INR decreases)
• With Increasing Body Mass Index
• Procoagulant factors VII and XIIa increase
• Fibrinolysis is impaired in that tissue
  Plasminogen Activator (tPA) decreases and
  Plasminogen Activator Inhibitor (PAI-1) increases
• Antithrombin and Protein C activity increase
• Bowles LK, et al. Blood Coagul Fibrinolysis
  200314569-73

Revised mmiiii
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M Ledford-Kraemer
2
Biological Variation-Females

• Menstruation
• Cyclic variations occur for Fibrinogen, VWFAg,
  VWFRCo (peak values in luteal phase)
• Testing for VWD should occur no later than day 7
  of a menstrual cycle
• Kadir RA. Thromb Haemost 1999821456-61
• Pregnancy
• Low grade process of intravascular coagulation
• Progressive increase in FVIII, VWFAg, and
  VWFRCo
• Menopause
• Higher levels of Fibrinogen FVII
• HRT increases FVII and decreases Antithrombin
  Protein S (most pronounced after initiation of
  drug)
• Lowe GDO, et al. Br J Haematol 199797775-84

Revised mmiiii
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M Ledford-Kraemer
3
Biological Variation-Age

• With Increasing Age
• Procoagulant proteins increase per decade
  Fibrinogen (9mg/dL), FV (6), FVIII (10), FIX
  (10), VWF (14), D-dimer (26)
• Platelets have lower aggregation thresholds (more
  responsive) to ADP and collagen
• Impaired fibrinolysis due to increases in TAFI
  (Thrombin Activatable Fibrinolysis Inhibitor) and
  PAI-1
• Wilkerson WR, et al. Semin Thromb Hemost
  200228(6)555-67

Revised mmiiii
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M Ledford-Kraemer
4
Biological Variation-Vices

• Caffeine
• Chronic consumption of caffeine (a
  methylxanthine) leads to a reduction in platelet
  aggregability due to upregulation of platelet A2A
  receptors
• Varani K. Circulation 2000102285-9
• Smoking
• Associated with cardiovascular disease
• Increases FVII antigen activity, FVIIa,
  Prothrombin Fragment 12 (F1.2), and FIX FX
  activation peptides
• Miller GJ, et al. Thromb Haemost 199879549-53

Revised mmiiii
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M Ledford-Kraemer
5
Biological Variation-Drugs

• Medications
• Warfarin affects vitamin K-dependent factors II,
  VII, IX, X. Over-anticoagulation can prolong
  both PT and APTT
• Heparin is ubiquitous!!!!!
•  Alcohol
• Moderate alcohol intake has no affect on
  coagulation or fibrinolysis
• Consumption of red wine has an inhibitory effect
  on platelet aggregation, which is caused by
  polyphenolic compounds in wine and not the
  alcohol
• De Lange DW, et al. Eur J Intern Med
  200314361-6

Revised mmiiii
www.CLOT-ED.com
M Ledford-Kraemer