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Updated: May 15, 2025

Mouse Complete Stasis Model of Inferior Vena Cava Thrombosis
Published on: June 15, 2011
Bidirectional two-sample Mendelian randomization analysis identifies protein C rather than protein S or
Liang Shu1, Liyan Sun2, Cong Yu3
1Department of Neurology, Shanghai Ninth People's Hospital, Shanghai, China.
Insights
Higher protein C levels are genetically linked to an increased risk of deep venous thrombosis (DVT). This association is partially mediated by body mass index, suggesting new avenues for DVT risk identification.
Area of Science:
- Genetics
- Thrombosis Research
- Epidemiology
Background:
- Observational studies suggest protein C and S influence thrombotic diseases.
- The "anticoagulation paradox" in deep venous thrombosis (DVT) remains unexplained.
- Causal links between anticoagulant proteins and DVT risk require elucidation.
Purpose of the Study:
- To investigate the causal effects of protein C, protein S, and antithrombin-III on DVT risk.
- To utilize a bidirectional Mendelian randomization (MR) framework for assessing these associations.
- To explore potential mediation pathways in the protein C-DVT relationship.
Main Methods:
- Employed a two-sample bidirectional Mendelian randomization (MR) framework.
- Utilized genome-wide association study data from 484,598 individuals for DVT.
- Conducted multivariable MR and two-step MR mediation analysis.
Main Results:
- Protein C showed a significant causal association with increased DVT risk (OR per SD increase: 1.005, p < 0.001).
- No significant causal associations were found for protein S (OR: 0.997, p = 0.146) or antithrombin-III (OR: 1.001, p = 0.456).
- Body mass index partially mediated the protein C-DVT association (11.4% mediated proportion).
Conclusions:
- Genetic variation in protein C levels, not protein S or antithrombin-III, is causally associated with DVT risk.
- Findings suggest protein C's role in DVT pathogenesis, potentially influenced by BMI.
- Offers insights for identifying individuals at higher genetic risk for DVT.
Introduction:
Observational studies have indicated significant contributions of protein C and protein S to thrombotic diseases, yet the "anticoagulation paradox" in deep venous thrombosis (DVT) remains unresolved. Therefore, we conducted an investigation to discern the causal effects of protein C, protein S and antithrombin-III on DVT risk.
Material And Methods:
We employed a two-sample (one to evaluate the gene-exposure relationship and the other to evaluate the gene-outcome relationship) bidirectional Mendelian randomization (MR) framework to assess the causal associations between protein C, protein S, antithrombin-III and DVT.
Results:
Genetic associations with DVT were extracted from a comprehensive genome-wide association study involving 484,598 individuals. In the multivariable MR analysis, the odds ratios for DVT per standard deviation (SD) increase were 1.005 (95% CI: 1.002-1.008; p < 0.001) for protein C, 0.997 (95% CI: 0.992-1.001; p = 0.146) for protein S, and 1.001 (95% CI: 0.998-1.005; p = 0.456) for antithrombin-III. A two-step MR mediation analysis revealed that the association between protein C and DVT was partially mediated by body mass index, with a mediated proportion of 11.4% (95% confidence interval, 2.3% to 79.2%).
Conclusions:
These findings provide insights into the genetic relationship between relative protein C rather than protein S or antithrombin-III levels and DVT, offering potential utility in identifying at-risk patients for DVT development.
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