[The role of hemostasis system in the pathogenesis and course of multiple sclerosis].

The influence of anticoagulation components of hemostasis system and lupus anticoagulants (LA) upon the course of multiple sclerosis (MS) was studied. 57 patients with MS diagnosed according to McDonald's criteria (McDonald WI et al., 2001) were examined: 19 males and 38 females aged 16-62 (mean age 36.8 +/- 11.2 yrs) with 1-25 yrs history of MS (mean duration 8.1 +/- 5.7 yrs). 42 patients suffered from relapsing-remitting MS, 17 patients were affected by secondary progressive MS. The degree of neurological deficit was estimated in remission according to Expanded Disability Status Scale (EDSS), mean score was 3.8 +/- 1.7. The progression of MS was estimated as EDSS score per year ratio. In patients with relapsing-remitting MS the mean number of exacerbations per year was calculated. The following laboratory findings were evaluated: thrombin clotting time, antithrombin-III activity, plasminogen reserve by the level of streptokinase-induced euglobulin fibrinolysis, protein C activity, factor Va resistance to activated protein C, lupus anticoagulants (LA). It was revealed that LA could worsen relapsing-remitting MS: in LA-positive patients there were 1.41 +/- 0.69 exacerbations per year and progression score reached 0.82 +/- 0.30, whereas in LA-negative patients the figures were 0.74 +/- 0.58 (p < 0.001) and 0.48 +/- 0.33 (p < 0.01) respectively. All the patients showed decrease of protein C activity (p < 0.001) with no relation to LA activity or factor Va resistance to activated protein C. Normal level of plasminogen and antithrombin-III activity was supposed to be the marker of benign variant of MS. The course of MS was mild in patients with high antithrombin-III activity even if they were hypercoagulative--this suggests neuroprotective activity of antithrombin-III which may relate not only to its anticoagulation effect.