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Simon Chang Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Internal Medicine, Lillebaelt Hospital, Kolding, Denmark

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Arkadiusz J Goszczak NanoSYD, The Mads Clausen Institute, University of Southern Denmark, Sønderborg, Denmark

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Anne Skakkebæk Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark

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Jens Fedder Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark

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Anders Bojesen Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark

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M Vakur Bor Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark

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Moniek P M de Maat Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

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Claus H Gravholt Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark

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Anna-Marie B Münster Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark

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Objective

Klinefelter syndrome (KS) is associated with increased risk of thrombosis. Hypogonadism and accumulating body fat in KS have a potential impact on fibrinolysis. In this study, we assessed the fibrinolytic system and the association with testosterone levels in KS.

Design

This study is a cross-sectional comparison of men with KS and age-matched male controls.

Methods

Fibrin clot lysis was evaluated by turbidity measurements and by measuring levels of individual fibrinolytic proteins in plasma samples. Fibrin clot structure was evaluated by scanning electron microscopy. Total testosterone was measured by liquid chromatography-tandem mass spectrometry. Body fat was evaluated by dual-energy X-ray absorptiometry.

Results

In this study, 45 men with KS and 45 age- and education-matched controls were included. Men with KS had a 24% reduction in fibrin clot lysis compared with controls (46.2 ± 17.1 vs 60.6 ± 18.8 %/h, P  = 0.0003) and higher levels of fibrinogen, factor XIII (P ≤ 0.01), and plasminogen activator inhibitor type 1 (P  = 0.04). Men with KS had lower total testosterone (P  = 0.008) and higher body fat (P  = 0.001). In KS, reduced fibrin clot lysability was associated with higher fibrinogen and body fat related to decreasing total testosterone and hypogonadism among men with KS. Fibrin clot structure was not different compared to KS and controls.

Conclusions

Fibrin clot lysis in KS was markedly reduced, potentially contributing to a prothrombotic state and increasing thrombotic risk. Hypogonadism in KS was associated with increased fibrinogen and total body fat, predicting reduced fibrin clot lysis.

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