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Diminished response to activated protein C is not correlated with severity of peripheral arterial occlusive disease
1Department of Internal Medicine, Medical University of Graz, Austria. herwig.koeppel@klinikum-graz.at
Introduction:
Poor response to activated Protein C (APC) is a well established risk factor for venous thromboembolism. More recently, the hypercoagulable state which results from diminished response to APC has also been associated with arterial thrombosis. Some studies showed a clear association between low response to APC with advanced arterial disease, others, however, failed to support these data. Thus, there is ongoing dispute about the impact of a hypercoagulable state upon progression of atherosclerosis.
Material And Methods:
We investigated APC ratios and the existence of Factor V Leiden in 800 patients with documented peripheral arterial occlusive disease (PAD). Clinical symptoms according to Fontaine stages II (intermittent claudication), III (rest pain) and IV (gangrene) and the ankle/brachial index served as parameters for the severity of PAD.
Results:
There was no association between low response to APC or existence of Factor V Leiden and the clinical stage of PAD or ankle/ brachial index.
Conclusion:
Our data suggest that poor response to APC is not correlated with the severity of peripheral arterial occlusive disease.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...