Coagulation Abnormalities in Behcet's Disease

Kang, Seong Wook; Shin, Ki Chyul; Lee, Yun Jong; Lee, Eun Bong; Baek, Han Joo; Kim, Hyun Ah; Song, Yeong Wook

Abstract

OBJECTIVE
The predominant histopathologic lesion in Behcet's disease is vasculitis. Thrombotic complications have been reported in approximately 10-40% of patients with Behcet's disease, but the precise mechanisms are not known. To investigate the coagualtion abnormalities in patients with Behcet's disease, coagulation and fibrinolytic activities were examined.
METHODS
Thirty-two patients with Behcet's disease and thirty-two healthy individuals as a control group were included in the study. The presence of thrombosis and risk factors for hypercoagulability, and blood components concerning coagulation and fibrinolytic activites were evaluated.
RESULTS
Of thirty-two patients with Behcet's disease, thrombosis was found in four patients(13%). No patient had risk factors for hypercoagulability except one with lymphoma. Levels of white blood cell count(mean+/-SD 8,362+/-2,893 vs 5,934+/-1,755/mm2, p<0.001), erythrocyte sedimentation rate(40.5+/-37.6 vs 3.3+/-2.73mm/hr, p<0.001), C reactive protein(2.26+/-3.99 vs 1.20+/-0.26mg/dl, p=0.008), fibrinogen(387.7+/-128.5 vs 240.6+/-49.5mg/dl, p<0.001) and von Willebrand factor antigen(131.9+/-46.6 vs 105.2+/-1.75%, p=0.008) were significantly higher in patients with Behcet's disease compared with controls. The level of fibrinogen correlated with erythrocyte sedimentation rate(r=0.721, p<0.001) and C reactive protein(r=0.454, p=0.018). High density lipoprotein(HDL) cholesterol(46.6+/-12.7 vs 65.5+/-16.1mg/dl, p<0.001), apolipoprotein A-1(118.8+/-24.7 vs 134.6+/-18.5mg/dl, p=0.018) and antithrombin III(92.8+/-16.7 vs 106.3+/-14.7%, p=0.004) were significantly lower in patients with Behcet's disease. No differences were observed in lipoprotein(a), plasminogen, protein C, and protein S activities. Activated protein C(APC) resistance was not observed in any patients with Behcet's disease. Lupus anticoagulant was positive in four patients(13%), one of whom had deep vein thrombosis. Antiphospholipid antibody was found in one patient(3%), but thrombosis was not found.
CONCLUSIONS
Significantly higher level of von Willebrand factor antigen was observed in Behcet's disease, which suggested injury of vascular endothelium. Levels of HDL cholesterol, apolipoprotein A-1 and antithrombin III were decreased in Behcet's disease. APC resistance was not found.