The relationship between
protein Z levels and
thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between
protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed
protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low
protein Z levels were associated with an increased risk of
thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12; p<0.00001). On subgroup analysis, a significant association was found between low
protein Z levels and arterial
vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002),
pregnancy complications (OR 4.17, 95%CI 2.31-7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this meta-analysis are consistent with a role for
protein Z deficiency in thrombotic diseases, including arterial
thrombosis,
pregnancy complications and
venous thromboembolism.