1
|
Solela G, Aschenek A, Amsalu C. Recurrent deep vein thrombosis in a young patient of African descent: challenging the prevailing stance on the significance of MTHFR C677T mutation. Oxf Med Case Reports 2023; 2023:omad132. [PMID: 38145269 PMCID: PMC10735354 DOI: 10.1093/omcr/omad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 12/26/2023] Open
Abstract
Background Although numerous gene variations, such as those in the methylenetetrahydrofolate reductase (MTHFR) gene, have been implicated in an increased risk of venous thrombosis, current recommendations do not advocate genetic testing if there is no clinically meaningful association with thrombosis. Case Presentation A 30-year-old male patient presented with left lower limb swelling of two days with prior history of deep vein thrombosis and superficial thrombophlebitis. His left lower limb was grossly swollen. Doppler study showed thrombosis of left common femoral, superficial femoral and iliac veins and work up for inherited thrombophilia was negative except detection of MTHFR C677T mutation. Conclusion In spite of the great controversy regarding the strong association between MTHFR C677T mutation and venous thromboembolism, it is worth considering genetic testing as part of work-up for inherited thrombophilia in young patients, particularly of African descent, if they have recurrent deep vein thrombosis with no obvious risk factors.
Collapse
Affiliation(s)
- Gashaw Solela
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Addis Aschenek
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Chali Amsalu
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| |
Collapse
|
2
|
Takhviji V, Zibara K, Maleki A, Azizi E, Hommayoun S, Tabatabaei M, Ahmadi SE, Soleymani M, Ghalesardi OK, Farokhian M, Davari A, Paridar P, Kalantari A, Khosravi A. A case-control study on factor V Leiden: an independent, gender-dependent risk factor for venous thromboembolism. Thromb J 2021; 19:74. [PMID: 34666770 PMCID: PMC8527672 DOI: 10.1186/s12959-021-00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Activated protein C resistance (APCR) due to factor V Leiden (FVL) mutation (R506Q) is a major risk factor in patients with venous thromboembolism (VTE). The present study investigated the clinical manifestations and the risk of venous thromboembolism regarding multiple clinical, laboratory, and demographic properties in FVL patients. MATERIAL AND METHODS A retrospective cross-sectional analysis was conducted on a total of 288 FVL patients with VTE according to APCR. In addition, 288 VET control samples, without FVL mutation, were also randomly selected. Demographic information, clinical manifestations, family and treatment history were recorded, and specific tests including t-test, chi-square and uni- and multi-variable regression tests applied. RESULTS APCR was found to be 2.3 times significantly more likely in men (OR: 2.1, p < 0.05) than women. The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in APCR patients was 4.5 and 3.2 times more than the control group, respectively (p < 0.05). However, APCR could not be an independent risk factor for arterial thrombosis (AT) and pregnancy complications. Moreover, patients were evaluated for thrombophilia panel tests and showed significantly lower protein C and S than the control group and patients without DVT (p < 0.0001). CONCLUSION FVL mutation and APCR abnormality are noticeable risk factors for VTE. Screening strategies for FVL mutation in patients undergoing surgery, oral contraceptive medication, and pregnancy cannot be recommended, but a phenotypic test for activated protein C resistance should be endorsed in patients with VTE.
Collapse
Affiliation(s)
- Vahideh Takhviji
- Transfusion Research center, High Institute for Research and Education in Transfusion, Tehran, Iran
| | - Kazem Zibara
- PRASE and Biology Department, Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - Asma Maleki
- Department of hematology, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Azizi
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sanaz Hommayoun
- Transfusion Research center, High Institute for Research and Education in Transfusion, Tehran, Iran
| | - Mohammadreza Tabatabaei
- Transfusion Research center, High Institute for Research and Education in Transfusion, Tehran, Iran
| | - Seyed Esmaeil Ahmadi
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maral Soleymani
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Omid Kiani Ghalesardi
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Farokhian
- Hematology Department, Tarbiat Modares University, Tehran, Iran
| | - Afshin Davari
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouria Paridar
- Islamic Azad University, North-Tehran Branch, Tehran, Iran
| | - Anahita Kalantari
- Department of Anesthesiology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Khosravi
- Transfusion Research center, High Institute for Research and Education in Transfusion, Tehran, Iran.
| |
Collapse
|
3
|
George AP, Kent P. The Impact of Multiple Risk Factors for Venous Thromboembolism and Its Implications for Management. Glob Pediatr Health 2019; 6:2333794X19859161. [PMID: 31259213 PMCID: PMC6589984 DOI: 10.1177/2333794x19859161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
Abstract
Venous thromboembolism (VTE) is a rare multifactorial disorder in childhood with an annual incidence of about 0.07 to 0.14 per 10 000 children. A 15-year-old female with a body mass index of 48 kg/m2 who endorsed oral contraceptive use presented with clinical findings consistent with deep venous thrombosis along with the presence of a pulmonary embolism. Further workup revealed that the patient was heterozygous for factor V Leiden and homozygous for prothrombin G20210A mutations. There are no current pediatric guidelines for the antithrombotic management of patients with multiple risk factors for VTE. Two such risk factors, obesity and the use of estrogen-containing hormone contraceptives, have been implicated in adult VTE cases but have not been clearly delineated in pediatric patients. The need for guidance regarding the VTE management of these patients has become more apparent given the increasing incidence of childhood obesity and the number of adolescents using oral contraceptives. Additionally, thrombophilia testing remains controversial though testing may be indicated in asymptomatic first-degree relatives and in families with antithrombin, protein C, or protein S deficiencies. Given the increased incidence of multiple risk factors for VTE, there is also a need to develop a comprehensive risk assessment tool for pediatric patients at high risk of VTE.
Collapse
Affiliation(s)
- Anil P George
- University of Illinois, Department of Pediatrics, Division of Hematology/Oncology, Chicago, IL, USA
| | - Paul Kent
- Rush University Medical Center, Department of Pediatrics, Division of Hematology/Oncology, Chicago, IL, USA
| |
Collapse
|
4
|
Near-complete recanalization of jugular vein and multiple dural sinus thromboses with warfarin in a case of antiphospholipid syndrome. Reumatologia 2018; 56:406-408. [PMID: 30647489 PMCID: PMC6330675 DOI: 10.5114/reum.2018.80720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022] Open
Abstract
Antiphospholipid syndrome is a cause of arterial and venous thrombosis especially in the young adult population. Although dural sinus thrombosis is a relatively rare complication of antiphospholipid syndrome, it may be a cause of morbidity and mortality. Extension of thrombosis and involvement of deep venous structures are poor prognostic factors in patients with dural sinus thrombosis, but the rate of near-complete recanalization is not known in antiphospholipid syndrome-related dural sinus thrombosis. Herein, a case of antiphospholipid syndrome with multiple dural sinus, deep cerebral vein and internal jugular vein thromboses is presented with demonstrative imaging findings and near-complete recanalization after warfarin.
Collapse
|
5
|
Daraban AM, Trifa AP, Popp RA, Botezatu D, Șerban M, Uscatescu V, Talmaci R, Coriu D, Ginghina C, Jurcut RO. Thrombophilia genetic testing in Romanian young women with acute thrombotic events: role of Factor V Leiden, Prothrombin G20210A, MTHFR C677T and A1298C polymorphisms / Evaluarea genetică a trombofiliilor la femei tinere din România cu evenimente acute trombotice: rolul Factorului V Leiden, Protrombinei G20210A, polimorfismelor MTHFR C677T și A1298C. REV ROMANA MED LAB 2016. [DOI: 10.1515/rrlm-2016-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract
Objective: The present case-control study aimed at evaluating the contribution of thrombophilic polymorphisms to acute venous (VTE) as well as arterial thrombotic events (ATE) in a population of young women with few traditional thrombotic factors (CVRF).
Methods: We consecutively enrolled patients under 45 years of age, with less than 3 CVRF, evaluated for VTE or ATE, women and men as a comparator. The control group consisted of healthy young women. A thrombophilia panel and genetic testing for Factor V Leiden (FVL), G20210A Prothrombin and MTHFR polimorphisms were done.
Results: A total of 323 persons were enrolled: 71 women and 121 men with thromboembolic events, and 131 healthy female as controls. Hyperhomocysteinemia was more frequent in ATE (30.4%) than VTE female patients (6.25%), p<0.01. Genetic testing was available in 45 women and 84 men with acute thrombotic events and in all controls. Homozygous FVL was associated with VTE in young women (10.3% vs 0% controls, p<0.01). Prothrombin G20210A polymorphism had the lowest prevalence – 5.4% and only heterozygosity was found. MTHFR C677T heterozygosity showed no significant difference between women patients and controls (62.2 % vs 43.5% respectively, p=0.1). The homozygous status, less frequent (6.6%), was not associated with ATE or VTE. Homozygous MTHFR A1298C was associated with VTE in women (17.2% patients vs 4.5% controls, OR 4.34, p 0.02, CI 1.22-15.3).
Conclusion: In young women with few CVRF, mild hyperhomocysteinemia, homozygosity for FVL and for MTHFR A1298C polymorphisms increase the risk for VTE but not ATE. MTHFR polymorphisms are found with increased frequency in both healthy persons and patients therefore, their significance as an important thrombotic risk modifier remains unclear.
Collapse
Affiliation(s)
- Ana Maria Daraban
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Pavel Trifa
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Anghel Popp
- Department of Medical Genetics, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Botezatu
- ”C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Marinela Șerban
- ”C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Valentina Uscatescu
- Center of Hemathology and Bone Marrow Transplantation, Clinical Fundeni Institute, Bucharest, Romania
| | - Rodica Talmaci
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Romania
- Center of Hemathology and Bone Marrow Transplantation, Clinical Fundeni Institute, Bucharest, Romania
| | - Daniel Coriu
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Romania
- Center of Hemathology and Bone Marrow Transplantation, Clinical Fundeni Institute, Bucharest, Romania
| | - Carmen Ginghina
- Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Romania
- ”C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Ruxandra Oana Jurcut
- ”C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| |
Collapse
|
6
|
Dubský M, Jirkovská A, Pagáčová L, Bém R, Němcová A, Fejfarová V, Wosková V, Jude EB. Impact of Inherited Prothrombotic Disorders on the Long-Term Clinical Outcome of Percutaneous Transluminal Angioplasty in Patients with Diabetes. J Diabetes Res 2015; 2015:369758. [PMID: 26247037 PMCID: PMC4515498 DOI: 10.1155/2015/369758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/18/2015] [Accepted: 06/29/2015] [Indexed: 12/29/2022] Open
Abstract
The aim of our study was to analyse inherited thrombotic disorders that influence the long-term outcome of PTA. Methods. Diabetic patients with peripheral arterial disease (PAD) treated by PTA in our centre between 2008 and 2011 were included in the study. Patients were divided into unsuccessful PTA group (75 patients), successful PTA group (58 patients), and control group (65 patients, with diabetes but no PAD). Diagnosis of inherited thrombotic disorders included mutation in factor V (Leiden), factor II (prothrombin), and mutation in genes for methylenetetrahydrofolate reductase-MTHFR (C677T and A1298C). Results. The genotypic frequency of Leiden allele G1691A was significantly associated with a risk of unsuccessful PTA in comparison with successful PTA group and control group (OR 8.8 (1.1-70.6), p = 0.041, and OR 9.8 (1.2-79.2), p = 0.032, resp.). However, we only observed a trend for the association of the prothrombin allele G20210A and risk of PTA failure. The frequencies of alleles of MTHFR 677 or 1298 did not differ significantly among the groups. Conclusion. Our study showed higher frequency of heterozygous form of Leiden mutation in diabetic patients with unsuccessful outcome of PTA in comparison with patients with successful PTA and diabetic patients without PAD.
Collapse
Affiliation(s)
- Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Libuše Pagáčová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Andrea Němcová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, 140 21 Prague, Czech Republic
| | - Edward B. Jude
- Diabetes Centre, Tameside Hospital NHS Foundation Trust and University of Manchester, Ashton-Under-Lyne OL6 9RW, UK
| |
Collapse
|
7
|
Hoteit R, Abbas F, Antar A, Abdel Khalek R, Shammaa D, Mahfouz R. Significance of the use of the ViennaLab "Cardiovascular Disease panel" (CVD) Assay as a reflex test for the "Factor V/II/MTHFR Assay". Meta Gene 2015; 1:76-81. [PMID: 25606377 PMCID: PMC4205028 DOI: 10.1016/j.mgene.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/13/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction Trends toward identifying risk factors of thrombotic complications had become essential as an attempt to prevent and decrease the incidence of the complications. Thrombosis has been associated with predisposing factors like mutations in FV, PTH, MTHFR and other genes. Aim Evaluate whether the CVD StripAssay has an added value in the screening for more thrombophilia risk factors, which may predispose for the development of cardiovascular diseases and other thrombotic clinical conditions. Methods We compared the results for 94 patients who were previously tested for Factor V, Factor II and MTHFR gene mutations using the ViennaLab FV-PTH-MTHFR StripAssay, and for whom additional testing for the Cardiovascular Disease panel (CVD StripAssay, ViennaLab) was requested. Results Using the CVD StripAssay, 66% of patients who had no mutations when tested using the FV-PTH-MTHFR StripAssay or carried a mutation for MTHFR, were found to have additional genes' SNPs or mutations that are highly associated with a risk of thrombosis as per the available international literature. Conclusion This observation is of extreme importance in clinical practice for the introduction of the extended CVD panel into routine molecular diagnostic test menus and highlights the importance of genetic analysis of the implicated genes in the management of patients with a thrombotic episode presentation. First paper in the literature that compares the use of two assays to detect mutations in genes involved in thrombosis. The common genes involved in thrombosis may not be enough alone to consider a patient “negative” for genetic predisposition. Molecular diagnostics laboratories should consider expanding their services to include a more extensive genetic thrombophilia profiling.
Collapse
Affiliation(s)
- Rouba Hoteit
- Department of Pathology & Laboratory Medicine, AUBMC, Lebanon
| | - Fatmeh Abbas
- Department of Pathology & Laboratory Medicine, AUBMC, Lebanon
| | - Ahmad Antar
- Department of Internal Medicine, AUBMC, Lebanon
| | | | - Dina Shammaa
- Department of Pathology & Laboratory Medicine, AUBMC, Lebanon
| | - Rami Mahfouz
- Department of Pathology & Laboratory Medicine, AUBMC, Lebanon
- Corresponding author at: American University of Beirut Medical Center (AUBMC), Department of Pathology & Laboratory Medicine, P.O BOX 11–0236, Riad El Solh 1107 2020, Beirut, Lebanon. Tel.: + 961 3 737017; fax: + 961 1 370845.
| |
Collapse
|
8
|
Sciascia S, Sanna G, Khamashta MA, Cuadrado MJ, Erkan D, Andreoli L, Bertolaccini ML. The estimated frequency of antiphospholipid antibodies in young adults with cerebrovascular events: a systematic review. Ann Rheum Dis 2014; 74:2028-33. [PMID: 24942381 DOI: 10.1136/annrheumdis-2014-205663] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/01/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Around 10% of all thrombotic cerebrovascular events (CVE) occur in young population and in a large proportion of those the trigger remains undetermined. Antiphospholipid antibodies (aPL) are recognised risk factors for ischaemic stroke and recurrent thrombotic events; however, the frequency of aPL in young people with CVE is still an unresolved issue. OBJECTIVES To estimate the frequency of aPL in young adults with CVE and to determine whether aPL-positive young individuals are at greater risk of CVE when compared with individuals without aPL by systematically reviewing the literature. METHODS Medline reports published between 1970 and 2013 investigating the presence of aPL in young patients (<50 years old) with CVE were included. The median frequency for positive aPL, including lupus anticoagulant, anticardiolipin antibodies (aCL) and antibodies against β2Glycoprotein I (anti-β2GPI), was calculated for stroke and transient ischaemic attacks. FINDINGS This systematic review is based on available data from 5217 patients and controls from 43 studies analysing the frequency of aPL in young patients with CVE. The overall aPL frequency was estimated as 17.4% (range 5%-56%) for any CVE, 17.2% (range 2%-56%) for stroke and 11.7% (range 2%-45%) for transient ischaemic attack (TIA). The presence of aPL increased the risk for CVE by 5.48-fold (95% CI 4.42 to 6.79). Based on available data, the frequency of aPL in young patients with CVE can be estimated at 17%, rising up to 22% for aCL in patients with stroke. The presence of aPL seems to confer a fivefold higher risk for stroke or TIA when compared with controls. However, variability in test reproducibility and cut-off definition still represent an important methodological limitation for the current diagnostic testing for aPL. These observations should be confirmed by appropriately designed population studies.
Collapse
Affiliation(s)
- Savino Sciascia
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK Centro di Ricerche di Immunologia Clinica ed Immunopatologia e Documentazione su Malattie Rare (CMID), Università di Torino, Torino, Italy
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Munther A Khamashta
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Maria Jose Cuadrado
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, and Weill Medical College of Cornell University, New York
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Laura Bertolaccini
- Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, London, UK
| | | |
Collapse
|
9
|
Association between polymorphism of MTHFR c.677C>T and risk of cardiovascular disease in Turkish population: a meta-analysis for 2.780 cases and 3.022 controls. Mol Biol Rep 2013; 41:397-409. [PMID: 24264431 DOI: 10.1007/s11033-013-2873-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
Abstract
Cardiovascular diseases (CVDs) remain the main cause of morbidity and mortality around the world. A common polymorphism c.677C>T has been identified in the gene coding for methylenetetrahydrofolate reductase (MTHFR), which is involved in the remethylation of homocysteine, and may predispose to CVDs. A meta-analysis was performed to estimate the risk of CVDs associated with MTHFR c.677C>T in Turkish population. Published studies were retrieved from PubMed, Science Citation Index/Expanded, Google Scholar, Turkish Medline, and the Turkish Council of Higher Education Theses Database. For each study, we calculated odds ratios and 95 % confidence intervals (CI), assuming frequency of allele and homozygote comparison, dominant and recessive genetic models. Thirty-one separate studies were included and 2.780 cases/3.022 controls were involved in the current meta-analysis. Significant association was found between c.677C>T polymorphism and risk of CVD when all studies pooled with random-effects model for T versus C (OR 1.33; 95 % CI 1.11-1.59; p = 0.002), TT vs. CC (OR 1.87; 95 % CI 1.35-2.60; p = 3.53E-04), TT+CT vs. CC (OR 1.32; 95 % CI 1.06-1.64; p = 0.014) and TT vs. CT+CC (OR 1.75; 95 % CI 1.29-2.37; p = 6.57E-04). Further analysis indicated the significant association between methylenetetrahydrofolate reductase (MTHFR) TT genotype and groups with venous thrombosis, peripheral arterial thrombosis, acute MI/MI. No publication bias was observed in any comparison model. Our results of meta-analysis suggest that MTHFR c.677C>T polymorphism is associated with the CVDs in Turkish population.
Collapse
|
10
|
Hadhri S, Rejab MB, Guedria H, Ifa L, Chatti N, Skouri H. Factor V Leiden, prothrombin 20210G>A, MTHFR 677C>T and 1298A>C, and homocysteinemia in Tunisian blood donors. J Clin Lab Anal 2012; 26:167-73. [PMID: 22628232 DOI: 10.1002/jcla.21506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Specific genetic conditions are known to be associated with high risk of venous thromboembolism. This genetic basis varies widely between ethnic groups. We investigated the distribution of four inherited polymorphisms in 113 unselected Tunisian blood donors by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The allele frequencies of Factor V Leiden (FVL), prothrombin 20210G>A, methylenetetrahydrofolate reductase (MTHFR) 677C>T, and MTHFR 1298A>C mutations were 3, 0.9, 30, and 31%, respectively. The MTHFR 677C>T polymorphism was influenced by age. Twenty-nine of the 113 blood donors demonstrated more than one genetic markers. Hyperhomocysteinemia was found in 12 subjects, and it was statistically associated to the MTHFR 677TT genotype. Principal component analysis allowed disclosing the resemblance between Mediterranean populations. Our findings may be helpful for population genetics study, and provide epidemiologic database for further studies in thrombosis field among Tunisians.
Collapse
Affiliation(s)
- Samira Hadhri
- Laboratoire d'Hématologie et Banque du Sang, CHU Sahloul, Sousse, Tunisia
| | | | | | | | | | | |
Collapse
|
11
|
Hoteit R, Halas H, Hassanieh S, Mahfouz RAR. Laboratory referral rates of genetic tests for thrombophilia workup in a major referral center. Genet Test Mol Biomarkers 2011; 16:459-62. [PMID: 22191678 DOI: 10.1089/gtmb.2011.0220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The rate of laboratory referrals for thrombophilia patients' genetic workup was assessed and compared among the medical and surgical specialties and subspecialties at a major tertiary care center in Lebanon. METHODS DNA extraction was performed using the PEL-FREEZ extraction kit (PEL-FREEZ; DYNAL) and the Factor V, prothrombin, and methylenetetrahydrofolate reductase genotypic profiles were done using the FV-PTH-MTHFR StripAssay kit (ViennaLab) that employs a polymerase chain reaction-reverse hybridization method. A total of 2238 referred cases were analyzed. RESULTS Around 42.23% of all referred cases turned out to have a thrombosis-associated mutation. Referrals from medical and surgical specialties were almost equal. In the surgical specialty, most referrals came from the department of Obstetrics and Gynecology, while in the medical speciality, most of the workup referrals originated from the Hematology/Oncology physicians. However, low referral rates were reported from the emergency department and family medicine practitioners. CONCLUSION Genetic testing for thrombophilia workup is gaining more importance among the different medical and surgical specialties and is worth being introduced into the offered test lists of all established molecular diagnostics laboratories.
Collapse
Affiliation(s)
- Rouba Hoteit
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | |
Collapse
|
12
|
Glueck CJ, Goldenberg N, Budhani S, Lotner D, Abuchaibe C, Gowda M, Nayar T, Khan N, Wang P. Thrombotic events after starting exogenous testosterone in men with previously undiagnosed familial thrombophilia. Transl Res 2011; 158:225-34. [PMID: 21925119 DOI: 10.1016/j.trsl.2011.06.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 06/02/2011] [Accepted: 06/05/2011] [Indexed: 11/28/2022]
Abstract
Our specific aim was to describe thrombosis (osteonecrosis of the hips, pulmonary embolism, and amaurosis fugax) after exogenous testosterone was given to men with no antecedent thrombosis and previously undiagnosed familial thrombophilia. After starting testosterone patch or gel, 50 mg/day or intramuscular testosterone 400 mg IM/month, 2 men developed bilateral hip osteonecrosis 5 and 6 months later, and 3 developed pulmonary embolism 3, 7, and 17 months later. One man developed amaurosis fugax 18 months after starting testosterone gel 50 mg/day. Of these 6 men, 5 were found to have previously undiagnosed factor V Leiden heterozygosity, 1 of whom had ancillary MTHFR C677T homozygosity, and 2 with ancillary MTHFR C677T-A1298C compound heterozygosity. One man had high factor VIII (195%), factor XI (179%), and homocysteine (29.3 umol/L). Thrombotic events after starting testosterone therapy are associated with familial thrombophilia. We speculate that when exogenous testosterone is aromatized to E2, and E2-induced thrombophilia is superimposed on familial thrombophilia, thrombosis occurs. Men sustaining thrombotic events on testosterone therapy should be screened for the factor V Leiden mutation and other familial and acquired thrombophilias.
Collapse
Affiliation(s)
- Charles J Glueck
- Jewish Hospital Cholesterol Center, Jewish Hospital of Cincinnati, Ohio 45220, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|