Vascular involvement in Behçet’s disease: relation with thrombophilic factors, coagulation activation, and thrombomodulin

Abstract Purpose Thrombosis, usually venous, occurs in 10% to 25% of patients with Behçet’s disease, but its pathogenesis is poorly understood. We evaluated parameters of hemostasis and their relation with thrombosis in a series of patients with Behçet’s disease. Subjects and methods We studied 38 patients with Behçet’s disease (13 with venous thrombosis), 38 patients with venous thrombosis without thrombophilia, and 100 control subjects. Levels or presence of protein C, protein S, antithrombin, methylenetetrahydrofolate reductase C677T, factor V Leiden, prothrombin gene G20210A, antiphospholipid antibodies, plasminogen, tissue-type plasminogen activator (tPA), type-1 tPA inhibitor (PAI-1), PAI-1 4G/5G polymorphism, prothrombin fragment 1+2, plasmin/α2-antiplasmin complexes, thrombomodulin, and activated factors VII and XII were determined. Results There were no deficiencies in protein C, protein S, antithrombin, or factor V Leiden in the patients with Behçet’s disease, nor was there evidence of most other thrombotic abnormalities. Compared with control subjects, however, the Behçet’s disease group had elevated mean (±SD) levels of prothrombin fragment 1+2 (2091 ± 1323 pmol/L vs. 804 ± 398 pmol/L, P<0.001), plasmin/α2-antiplasmin complexes (410 ± 220 μg/L vs. 214 ± 92 μg/L, P<0.001), and thrombomodulin (37 ± 24 ng/mL vs. 27 ± 10 ng/mL, P<0.001). These levels did not differ between patients with or without thrombosis. Conclusion Thrombophilic factors do not seem to explain most thromboses in Behçet’s disease. There is increased thrombin generation, fibrinolysis, and thrombomodulin in Behçet’s disease, but these abnormalities are not related to thrombosis.