1
|
Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J. Genetic risk factors for venous thromboembolism. Expert Rev Hematol 2020; 13:971-981. [DOI: 10.1080/17474086.2020.1804354] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Peter J. Svensson
- Center for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn Dahlbäck
- Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Christina Lind-Hallden
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Christer Hallden
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Johan Elf
- Center for Thrombosis and Haemostasis, Lund University, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
2
|
Simioni P, Scalia D, Tormene D, Bongiovi S, Sardella C, Girolami A. Intra-Atrial Thrombosis and Homozygous Factor V Leiden Mutation. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969700300312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 55-year-old woman with a previous history of thrombotic manifestations developed large left atrial thrombosis. Coagulative screening demonstrated the presence of severe activated protein C resistance due to homozygous factor V Leiden mutation that could explain the thrombophilic state in this patient. No other associated coagulation defects predisposing to thrombosis were identified. At the time of diagnosis of intra-atrial thrombosis, the patient presented with a moderate mitral valve stenosis and atrial fibrillation of recent onset. Both these conditions may account for the presence of left atrial thrombosis but it is suggested that inherited thrombophilia due to homozygous factor V Leiden mutation might have represented an additional predisposing factor for the development of the thrombotic phenomenon. The role of coagulation defects predisposing to thrombosis in the pathogenesis of intracardial thrombosis in patients with or without valvular diseases is still unknown and proper studies are required. Key Words: Thrombophilia-Factor V Leiden-Atrial thrombosis.
Collapse
Affiliation(s)
- Paolo Simioni
- Padua Hospital and Institute of Medical Semeiotics, University of Padua Medical School
| | - Domenico Scalia
- Institute of Cardiovascular Surgery, University of Padua Medical School
| | - Daniela Tormene
- Padua Hospital and Institute of Medical Semeiotics, University of Padua Medical School
| | | | - Corrado Sardella
- Padua Hospital and Institute of Medical Semeiotics, University of Padua Medical School
| | - Antonio Girolami
- Padua Hospital and Institute of Medical Semeiotics, University of Padua Medical School
| |
Collapse
|
3
|
Zöller B, Hillarp A, Dahlbäck B. State-of-the-Art Review: Activated Protein C Resistance: Clinical Implications. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969700300103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The discovery of inherited resistance to activated protein C (APC) as a major risk factor for venous thrombosis has dramatically improved our understanding of the pathogenesis of venous thrombosis. In a majority of cases, APC resistance is associated with a single point mutation in the factor V gene (FV) that results in substitution of arginine, R, at position 506 by glutamine, Q. (FV:Q506). The mutation renders factor Va partially resistant to degradation by APC. A functional APC resistance test, which includes predilution of the patient plasma with factor V-deficient plasma, is found to be 100% sensitive and specific for the presence of FV:Q506and is useful as a screening assay. Carriers of the FV:Q506allele have increased thrombin generation, resulting in hypercoagulability and a lifelong increased risk of venous thrombosis. In Western countries, APC resistance due to the FV mutation is present in 20-60% of thrombosis patients and in 1-15% of healthy controls, whereas the mutation is virtually absent from ethnic groups other than Caucasians. This may explain the high incidence of venous thrombosis in Western countries. The thrombotic risk in APC-resistant individuals may be further increased by other genetic defects, e.g., protein C or protein S deficiency, and by exposure to circumstantial risk factors, e.g., oral contraceptives, pregnancy, immobilization, and surgery. The question is thus raised as to whether general screening for APC resistance before circumstantial risk factors occur is warranted in Western countries. Key Words: Factor V—APC resistance-Protein C-Protein S—Thrombosis—Mutation.
Collapse
Affiliation(s)
- Bengt Zöller
- Department of Clinical Chemistry, University of Lund, University Hospital, Malmö, Sweden
| | - Andreas Hillarp
- Department of Clinical Chemistry, University of Lund, University Hospital, Malmö, Sweden
| | - Björn Dahlbäck
- Department of Clinical Chemistry, University of Lund, University Hospital, Malmö, Sweden
| |
Collapse
|
4
|
Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2010; 42:227-76. [PMID: 20966421 DOI: 10.1161/str.0b013e3181f7d043] [Citation(s) in RCA: 1266] [Impact Index Per Article: 90.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches to the implementation of guidelines and their use in high-risk populations.
Collapse
|
5
|
Eshtehardi P, Eslami M, Moayed DA. Simultaneous subacute coronary drug-eluting stent thrombosis in two different vessels of a patient with factor V Leiden mutation. J Cardiovasc Med (Hagerstown) 2008; 9:410-3. [PMID: 18334899 DOI: 10.2459/jcm.0b013e3282eee98b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We review the case of a 46-year-old man who underwent elective percutaneous coronary intervention and stenting of the left anterior descending artery and right coronary artery with two sirolimus- and paclitaxel-eluting stents. Four days after angioplasty, he was readmitted with cardiogenic shock due to acute anterior and inferior myocardial infarction. Coronary angiography revealed subacute thrombosis of both stents, and balloon dilation was performed successfully thereafter. The follow-up investigations revealed that the patient was a carrier of factor V Leiden. We hereby discuss the importance of factor V Leiden as the most common cause of hypercoagulable state and its probable role in acute and subacute coronary stent thrombosis in drug-eluting stents.
Collapse
|
6
|
Settin A, Dowaidar M, El-Baz R, Abd-Al-Samad A, El-Sayed I, Nasr M. Frequency of factor V Leiden mutation in Egyptian cases with myocardial infarction. Hematology 2008; 13:170-174. [DOI: 10.1179/102453308x316158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Ahmad Settin
- Genetic UnitGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Moataz Dowaidar
- Molecular Biology DepartmentGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Rizk El-Baz
- Genetic UnitGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Ayman Abd-Al-Samad
- Cardiology DepartmentInternal Medicine University Hospital, Mansoura, Egypt
| | - Ibrahim El-Sayed
- Cardiology DepartmentInternal Medicine University Hospital, Mansoura, Egypt
| | - Mahmoud Nasr
- Molecular Biology DepartmentGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| |
Collapse
|
7
|
Association between factor V Leiden mutation and coronary artery disease in the northeast region of Turkey. Blood Coagul Fibrinolysis 2007; 18:719-22. [DOI: 10.1097/mbc.0b013e3281139c55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Candito M, Candito E, Chatel M, van Obberghen E, Dunac A. Homocystéinémie et facteurs de thrombophilie dans des accidents de décompression immérités chez des plongeurs. Rev Neurol (Paris) 2006; 162:840-4. [PMID: 17028545 DOI: 10.1016/s0035-3787(06)75087-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Decompression sickness with cerebral ischemic lesions occurs even in divers who have not committed any technical error. This study sought to determine whether an acquired or inborn thrombophilic factor might be involved. METHODS 44 divers with ischemic medullar lesions (36 men, 8 women, mean age 39.9+/-4.7 yr) were compared with 44 controls (34 men, 10 women, mean age 38.2+/-5.1 yr). Coagulation screening included proteins S, C, and thrombin III and Factor VIII assays and circulating antibodies, Factor V Leiden, and mutation G20210A in Factor II gene research. Total plasma homocysteine (Hcy), an atherosclerosis factor (assayed by FPIA), folate and vitamin B12, (by microbiology), the cofactors of its metabolism, were assayed, and subjects were genotyped for mutation C677T on the MTHFR gene. RESULTS Coagulation screening--protein C, protein S, or antithrombin III deficit or mutation G20210A--was negative in all divers. 3/44 divers were heterozygous for Factor V Leiden, 1/44 had IgG antiphospholipid antibodies (9p.cent). While not found in controls, these percentages were not greater than those reported in the general population. 3/44 divers had elevated Factor VIII levels, but repeat assays on Day 2 were much lower. 11/44 divers had a moderate increase in Hcy value (20p.cent): in 7 divers, Hcy values were>15 micromol/L, and in 4 others>12, vs. 2.3p.cent of the controls; 2/11 had normal vitamin levels and 11 divers had folate or vitamin B12 deficiency or both, vs 2.3p.cent controls with a vitamin B12 deficit (percentage significantly different). 7/26 divers were homozygous for the C677T mutation, i.e. 27p.cent vs 12p.cent of 98 healthy controls (laboratory technicians). CONCLUSIONS A high percentage of unexplained diving accident victims had moderate HHC, a folate or vitamin B12 deficiency or both, that are easy to detect, plus a genetic predisposition to HHC or to coagulation abnormality. Easy-to-perform homocysteine, vitamin B12, and folate assays might prove helpful for primary prevention of diving accidents.
Collapse
Affiliation(s)
- M Candito
- INSERM U145 et Biochimie, Hôpital Pasteur, Centre Hospitalier Universitaire, Nice
| | | | | | | | | |
Collapse
|
9
|
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Circulation 2006. [DOI: 10.1161/circ.113.10.e409] [Citation(s) in RCA: 371] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
10
|
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke 2006; 37:577-617. [PMID: 16432246 DOI: 10.1161/01.str.0000199147.30016.74] [Citation(s) in RCA: 1153] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations.
Collapse
|
11
|
Kaykçoğlu M, Hasdemir C, Eroğlu Z, Kosova B, Can LH, Ildizli M, Yavuzgil O, Payzin S, Turkoglu C. Homozygous factor V Leiden mutation in two siblings presenting with acute myocardial infarction: a rare cause of myocardial infarction in the young. Blood Coagul Fibrinolysis 2005; 16:281-6. [PMID: 15870548 DOI: 10.1097/01.mbc.0000169221.38797.9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although factor V Leiden mutation, is the most common established genetic risk factor for venous thrombosis, its effect on the development of myocardial infarction remains unclear. We describe a family case of homozygous factor V Leiden mutation in two siblings presenting with acute myocardial infarction as a rare cause of myocardial infarction in the young.
Collapse
Affiliation(s)
- Meral Kaykçoğlu
- Department of Cardiology, Ege University, Medical School, 11/2 Bornova Izmir, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Greiner K, Peetz D, Winkgen A, Prellwitz W, Pfeiffer N, Hafner G. Genetic thrombophilia in patients with retinal vascular occlusion. Int Ophthalmol 2001; 23:155-60. [PMID: 11456253 DOI: 10.1023/a:1010639332737] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study was carried out to determine the prevalence of genetic thrombophilia in patients with retinal vascular occlusion. METHODS We investigated 116 consecutive patients with central retinal vein occlusion (CRVO, n = 48), branch retinal vein occlusion (BRVO, n = 33), central retinal artery occlusion (CRAO, n = 21), branch retinal artery occlusion (BRAO, n = 14). All patients underwent comprehensive tests for coagulation disorders including determinations of protein C, protein S, lupus anticoagulants, prothrombin gene mutation (G20210A), resistance to activated protein C (APCR), and were screened for vascular disease risk factors. APC resistance was confirmed by a PCR method to detect the factor V R506Q mutation. A PCR method was also used to detect the G20210A mutation. For comparative purposes, we screened 209 consecutive patients with deep vein thrombosis (DVT) and 581 patients with coronary heart disease (control group) for APC resistance. RESULTS 13 (27%) of 48 patients with CRVO had the factor V R506Q mutation. The factor V R506Q mutation was detected in six (18%) of 33 patients with BRVO, but in only one patient with CRAO and in two patients with BRAO. Other thrombophilic defects were not detected. The APCR prevalence within the CRVO group was significantly increased when compared to the control group (8%). There was no significant difference in the factor V R506Q mutation prevalence between the CRVO group and the DVT group (19%). CONCLUSION The factor V R506Q mutation is the most common cause of genetic thrombophilia in patients with CRVO and has a similar prevalence as in DVT patients.
Collapse
Affiliation(s)
- K Greiner
- Department of Ophthalmology, Johannes-Gutenberg-University, Mainz, Germany.
| | | | | | | | | | | |
Collapse
|
13
|
Mira Y, Todolí T, Alonso R, Micó TL, Vayá A, Ferrando F, Estellés A, Villa P, Aznar J. Factor V Leiden and prothrombin G20210A in relation to arterial and/or vein rethrombosis: two cases. Clin Appl Thromb Hemost 2001; 7:234-7. [PMID: 11441986 DOI: 10.1177/107602960100700310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The factor V Leiden (FV Leiden) and prothrombin G20210A mutations, are the most common established genetic risk factors for deep vein thrombosis (DVT). However, the relationship between these mutations and arterial thrombotic syndromes (coronary heart disease, myocardial infarction, stroke) has not been established. Some studies have suggested a relationship between them, but other authors have considered it unlikely that these anomalies are a major risk factor for arterial thrombosis. From the clinical point of view, a question arises concerning the risk of repeated thrombosis in patients carrying one of these two mutations. The question is whether the recurrence is attributable to the mutations or to the presence of additional circumstantial risk factors. As the risk of repeated thrombosis varies considerably from one patient to another, decisions about long-term treatment require weighing the persistence of risk factors for vascular disease (venous and arterial), especially in selected cases such as young patients or patients with thrombosis of unusual localization.
Collapse
Affiliation(s)
- Y Mira
- Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Hisar I, Ileri M, Yetkĭn E, Atak R, Senen K, Kosar F, Dŭndar S, Demĭrkan D. Role of activated protein C resistance in left atrial thrombogenesis in patients with mitral stenosis. Angiology 2000; 51:855-60. [PMID: 11108330 DOI: 10.1177/000331970005101008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Activated protein C resistance (APC-R) is the most common inherited cause of clinically apparent venous thromboembolism. Previous data indicate that left atrial thrombus (LAT) formation is a common complication in mitral stenosis (MS) and a hypercoagulable state exists in these patients. The aim of this study was to invastigate the association between APC-R and LAT formation in patients with MS. Seventy-seven consecutive patients with rheumatic MS were included in this study. Transesophageal echocardiography was performed on all patients to assess the presence of any thrombus or spontaneous echo contrast (LASEC) in the left atrial cavity or appendage. Thirty four of the patients had LAT and 43 did not. Prevelance of APC-R was smiliar between the two groups of patients with and without LAT (23% vs 16%, p=0.425). LAT(+) patients had higher incidence of atrial fibrillation (AF, 74% vs 51%, p=0.046) and LASEC (71% vs 19%, p<0.001) compared to LAT(-) patients. On multivariate regression analysis, only the presence of LASEC achieved statistical significance as an independent risk factor for LAT formation (p=0.0001, odds ratio=9.589, 95% confidence interval [CI] =3.143-29.251). Because onunivariate analysis both LASEC and AF were associated with LAT, we also compared the prevelance of APC-R in the subgroups of patients who have these risk factors with and without LAT. There was a correlation between the presence of APC-R and LAT in the AF(+) subgroup of MS patients (p=0.033, odds ratio=8.167, 95% CI=1.001-72.812). However, the presence of APC-R was not associated with the increased risk of LAT in LASEC(+) patients (p=0.217, odds ratio=1.200, 95% CI=1.003-1.435). Although the presence of APC-R itself is not an independent risk factor for LAT formation in MS, it may increase the risk of LAT when present in combination with AF (as an additional risk factor) in these patients.
Collapse
Affiliation(s)
- I Hisar
- Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Hacettepe University Medical School, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Becker RC. The Heparin Rebound Phenomenon-Does It Offer Insights Toward Understanding the Pathobiology of Coronary Thrombosis and Its Treatment? J Thromb Thrombolysis 1999; 1:157-161. [PMID: 10603525 DOI: 10.1007/bf01062573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- RC Becker
- Thrombosis Research Center, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
16
|
Sampram ES, Lindblad B, Dahlbäck B. Activated protein C resistance in patients with peripheral vascular disease. J Vasc Surg 1998; 28:624-9. [PMID: 9786256 DOI: 10.1016/s0741-5214(98)70086-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The frequency of activated protein C (APC) resistance, caused by factor V R506Q gene mutation and abnormal APC ratio, in patients with peripheral vascular diseases was analyzed. METHODS All patients electively admitted to the vascular ward unit of our tertiary care academic medical center from January 1995 through October 1996 (n = 679) were prospectively analyzed using an APC-resistance screening test to determine the frequency of abnormal APC ratio (< or =2.6). Baseline activated partial thromboplastin time (APTT) and its prolongation after the addition of a standard amount of APC were determined. The factor V R506Q gene mutation (Leiden) was analyzed in patients with an APC ratio less than 3.0. Statistical comparisons were made to an age-matched control population (n = 278). RESULTS The factor V Leiden gene mutation or abnormal APC ratio was detected in 154 of the patients (22.7%), compared with 34 of 278 the control subjects (12.2%; t = 13.65; P < .001). The factor V Leiden gene mutation was found in 102 patients (15.2%), compared with 29 control subjects (10.4%; t = 4.64; P < .05); an abnormal APC ratio was found in 132 patients (19.8%), compared with 26 (9.8%) of controls (t = 14.56; P < .001). The frequency of the factor V Leiden gene mutation was significantly increased in patients with femoro-popliteal occlusive disease (n = 126), to 21.6% (t = 16.94; P< .001), and venous disease (n = 50), to 36.0% (t = 20.93; P< .001). Overall, 63% of the patients with abnormal APC ratios tested positive for the factor V Leiden gene mutation. A significantly increased frequency of APC resistance was demonstrated in patients undergoing aorto-iliac (n = 37) or femoro-crural graft reconstructions (n = 72); it was found in 41% and 35%, respectively (P < .001). In addition, a significantly increased frequency of APC resistance was found in patients who suffered from occlusion after reconstruction; 13 of 41 (32%) had the factor V Leiden gene mutation (P < .001), and 19 of 39 (49%) had an abnormal APC ratio (P < .001). CONCLUSION The factor V Leiden gene mutation and abnormal APC ratios are significantly increased in patients with lower extremity peripheral vascular disease and failed reconstructions. An abnormal APC ratio was seen without factor V Leiden gene mutation in 37% of patients with peripheral vascular diseases, suggesting additional causes of an abnormal APC ratio, exclusive of gene mutation.
Collapse
Affiliation(s)
- E S Sampram
- Department of Vascular and Renal Diseases, Malmö University Hospital, Lund University, Sweden
| | | | | |
Collapse
|
17
|
Dacosta A, Tardy-Poncet B, Isaaz K, Cerisier A, Mismetti P, Simitsidis S, Reynaud J, Tardy B, Piot M, Decousus H, Guyotat D. Prevalence of factor V Leiden (APCR) and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries. HEART (BRITISH CARDIAC SOCIETY) 1998; 80:338-40. [PMID: 9875108 PMCID: PMC1728822 DOI: 10.1136/hrt.80.4.338] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the role of activated protein C resistance (APCR, factor V Leiden) in coronary artery thrombosis. METHODS The prevalence of APCR and of congenital deficiencies of antithrombin III, protein C, protein S, plasminogen, and factor XII was investigated in adult patients under 45 years of age with acute myocardial infarction. The results were compared with those of a group of 53 age and sex matched control subjects. RESULTS Among 75 patients under the age of 45 years who were admitted from November 1994 to April 1996 for acute myocardial infarction, 22 (29.3%) had normal coronary arteriography (group I) and 53 (70.7%) had significant coronary artery disease (group II). Inherited thrombophilia was more often found in group I (4/22, 18.2%) than in group II (4/53, 7.5%) but the difference was not significant (F test: p = 0.22). The prevalence of APCR was 9.1% (2/22) in group I, 3.8% (2/53) in group 2 (p = 0.57), and 3.8% (2/53) in the normal control group (p = 0.57). CONCLUSIONS The prevalence of congenital thrombophilias, including APCR, does not seem to be increased in young patients with myocardial infarction and normal coronary angiograms, compared with young patients with coronary atherosclerosis and with normal control subjects. However, the statistical power of the study is too low to detect a significant difference and these results are published to allow a meta-analysis of this problem in the future.
Collapse
Affiliation(s)
- A Dacosta
- Department of Cardiology, North Hospital, Saint-Etienne, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Dunn ST, Roberts CR, Schechter E, Moore WE, Lee ET, Eichner JE. Role of factor V Leiden mutation in patients with angiographically demonstrated coronary artery disease. Thromb Res 1998; 91:91-9. [PMID: 9722025 DOI: 10.1016/s0049-3848(98)00076-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The study sought to determine whether coagulation factor V Leiden (FV Leiden) plays a role in the pathogenesis of coronary artery disease and/or myocardial infarction. Association of FV Leiden with venous thromboembolism is well established in the literature, but the role of the mutation in arterial thrombotic events is controversial. Some studies have documented an association between the mutation and myocardial infarction and stroke in juveniles. Few studies have explored its possible contribution to coronary atherosclerosis. We screened FV genotype in 850 predominantly white coronary angiography patients. Coronary artery disease risk factors and history of myocardial infarction were then analyzed by genotype. The FV Leiden mutation occurred in 54 (6.4%) patients. There was one homozygote; a 37-year-old, white male smoker with a history of myocardial infarction. Gene frequencies for white males and females were similar: 0.965 for the normal allele and 0.035 for FV Leiden. Gene frequencies for both genders were in Hardy-Weinberg equilibrium. FV Leiden was not a useful predictor (p=0.23) of the presence of clinically defined atherosclerosis (> or = 50% stenosis) in a logistic regression model adjusting for age, lipoprotein (a), total cholesterol, triglycerides, high density lipoprotein cholesterol, and fibrinogen. In addition, there was no difference in frequency of FV Leiden among those with and without medical histories of myocardial infarction (p=0.51). Allelic frequencies of FV Leiden in this patient group do not differ significantly from those reported for white populations. The FV Leiden mutation in its heterozygous state is not independently associated with coronary artery disease or myocardial infarction.
Collapse
Affiliation(s)
- S T Dunn
- Department of Pathology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
| | | | | | | | | | | |
Collapse
|
19
|
Baranovskaya S, Kudinov S, Fomicheva E, Vasina V, Solovieva D, Khavinson V, Schwartz E. Age as a risk factor for myocardial infarction in Leiden mutation carriers. Mol Genet Metab 1998; 64:155-7. [PMID: 9705241 DOI: 10.1006/mgme.1998.2697] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A single factor V gene G-A mutation (Arg506Gln) underlying activated protein C (APC) resistance is a common risk factor for venous thromboembolism. It is still unclear whether the factor V Leiden predisposes patients to arterial thrombosis and myocardial infarction (MI). To determine a correlation between the factor V Leiden mutation and MI in different age categories, DNA samples from 287 patients with "early" and "late" MI were investigated. As control groups 373 young subjects (mean age 11 years) and 110 elderly ones (mean age 80 years) were studied. We found a significant difference in mutant allele distribution in the "late" MI group compared to the "early" MI group (chi2 = 9.86, OR = 13,7, P < 0.005) and the control group of elderly subjects (chi2 = 5.92, OR = 8.6, P < 0.02). The mean age of MI patients carrying the Leiden mutation was 72 years, i.e., 12 years higher than the mean age of all investigated MI patients (60 years). Thus, we found a statistically significant correlation between MI and factor V Leiden mutation in elderly subjects.
Collapse
Affiliation(s)
- S Baranovskaya
- Laboratory of Human Molecular Genetics, Petersburg Nuclear Physics Institute, St.Petersburg Area, 188350, Russia
| | | | | | | | | | | | | |
Collapse
|
20
|
Arnljots B, Söderström T, Svensson H. No correlation between activated protein C resistance and free flap failures in 100 consecutive patients. Plast Reconstr Surg 1998; 101:1850-3. [PMID: 9623826 DOI: 10.1097/00006534-199806000-00011] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study evaluates whether thrombophilic disorders contribute to failures in microvascular surgery. A recently discovered condition is focused on, i.e., activated protein C resistance, which is a highly prevalent functional defect of a crucial endogenous anticoagulant system--the protein C anticoagulant pathway (up to 15 percent of Caucasians affected). One hundred consecutive patients were operated on with 103 free tissue transfers during a 2.5-year period, all of which received perioperative intravenous anticoagulation, principally based on dextran (1 liter) and a heparin bolus at vascular reperfusion (80 to 100 IU/kg). The patients underwent extensive laboratory analysis with respect to conditions predisposing for thrombosis. Eleven patients were found to be activated protein C resistant, and one patient had congenital protein S deficiency. There were six total and five partial flap losses, which, however, in only one case coincided with the presence of a thrombophilic disorder (activated protein C resistance). By contrast, a substantial portion of flap necroses could be related to nonconstitutional factors (for example, pedicle kinking). It is concluded that routine screening for hypercoagulable states such as activated protein C resistance is not necessary in microvascular surgery.
Collapse
Affiliation(s)
- B Arnljots
- Department of Plastic and Reconstructive Surgery, University Hospital, Malmö, Sweden
| | | | | |
Collapse
|
21
|
Mac Hale JL, Nathan N, D'Ambra M. Intrinsic Anticoagulation: Protein C, Protein S, and Thrombomodulin. Semin Cardiothorac Vasc Anesth 1997. [DOI: 10.1177/108925329700100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The protein C anticoagulant system provides important control over the blood coagulation cascade. Any alteration in this pathway, either hereditary, iatrogenic, or otherwise, may interfere with normal coagulation. In this review, current concepts and understanding of surface-dependent hemostatis are reviewed, effects of deficiencies in the intrinsic anticoagulant system are described, and potentially useful therapeutic strategies are proposed. The importance of protein C, protein S, and thrombomodulin in patients undergoing cardiac surgery is specifically addressed. Further work is required before complex interactions of individual components of the intrinsic anticoagulation pathway are fully understood.
Collapse
Affiliation(s)
- John L. Mac Hale
- Department of Cardiac Anaesthesia, Massachusetts General Hospital, Boston, MA
| | - Nadia Nathan
- Department of Cardiac Anaesthesia, Massachusetts General Hospital, Boston, MA
| | - Michael D'Ambra
- Department of Cardiac Anaesthesia, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
22
|
Artemis N, Heliopoulos J, Makris P, Piperidou H, Milonas J. Bilateral central retinal artery occlusions in a patient with activated protein C resistance. Eur J Neurol 1997. [DOI: 10.1111/j.1468-1331.1997.tb00369.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Factor V Leiden (Resistance to Activated Protein C) Increases the Risk of Myocardial Infarction in Young Women. Blood 1997. [DOI: 10.1182/blood.v89.8.2817] [Citation(s) in RCA: 261] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractFactor V Leiden (factor V Arg506Gln), the genetic defect underlying resistance to activated protein C, is the most common risk factor for venous thrombosis. The relationship between this genetic abnormality and arterial disease is still unresolved. To assess whether factor V Leiden increases the risk of myocardial infarction (MI), we conducted a population-based case-control study among women 18 to 44 years of age in western Washington state. We included 84 women with first MI and 388 control women, ie, women residing in the same area in the same age range without MI (n = 388). The control women were contacted by random digit dialing. Data on risk factor status were collected via personal interview, and data on the factor V genotype via polymerase chain reaction techniques. The factor V Leiden mutation was found more often in women with MI (10%) than among controls (4%). The odds ratio for MI was 2.4 [95% confidence interval (CI) 1.0 to 5.9]. The risk was increased fourfold (CIgs 1.2 to 12.1) when adjusted for major cardiovascular risk factors. Among nonsmokers the factor V Leiden mutation had little effect (odds ratio 1.1, CI95 0.1 to 8.5), whereas it had a large effect among smokers (odds ratio 3.6, CI95 0.9 to 14.4), which, because smoking was itself a strong risk factor for MI, led to an odds ratio for smoking carriers of the mutation that was 32-fold increased compared with nonsmoking noncarriers. We conclude that factor V Leiden increases the risk of MI in young women. This effect seems to be confined largely to current smokers.
Collapse
|
24
|
Hallak M, Senderowicz J, Cassel A, Shapira C, Aghai E, Auslender R, Abramovici H. Activated protein C resistance (factor V Leiden) associated with thrombosis in pregnancy. Am J Obstet Gynecol 1997; 176:889-93. [PMID: 9125617 DOI: 10.1016/s0002-9378(97)70617-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium. STUDY DESIGN This observational study was conducted prospectively during a 2-year period (July 1993 to June 1995) in a preselected population. All patients admitted to our high-risk pregnancy unit with a diagnosis of deep vein thrombosis, pulmonary emboli, transient ischemic attack, and cerebrovascular accident during pregnancy and the puerperium were included. Prothrombin time, partial thromboplastin time, fibrinogen levels, protein C, protein S, antithrombin III, functional test for activated protein C resistance, and factor V Leiden mutation by polymerase chain reaction were performed on each patient. RESULTS Fifteen patients were included. Seven (46.6%) patients were positive for activated protein C resistance (factor V Leiden). All other coagulation studies were negative for all patients. All patients with activated protein C resistance had a venous thrombotic event, deep vein thrombosis, or pulmonary emboli, and only one had a cerebrovascular accident on the basis of sagittal sinus thrombosis. Only two of the activated protein C resistance-negative patients had venous thrombosis (pulmonary emboli). The remaining six patients had transient ischemic attacks or cerebrovascular accidents. For the subgroup with venous thrombosis during pregnancy and the puerperium, the incidence of activated protein C resistance (factor V Leiden) was 78%. CONCLUSION This study demonstrates the incidence of factor V Leiden in a selected population in whom thrombotic events developed during pregnancy and the puerperium. This small-scale study provides justification for a large cohort study that will identify women with factor V Leiden and determine their risk for thrombosis during pregnancy and the puerperium. We believe that factor V Leiden should be evaluated in conjunction with thrombotic events in the pregnant woman.
Collapse
Affiliation(s)
- M Hallak
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48235, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Keung YK, Cobos E, Barber A, Ronaghan C, Whitehead R, Staton M, Gilbert M, Morgan D. Relationship Between Activated Protein C Resistance and Central Venous Device-Related Complications. Clin Appl Thromb Hemost 1997. [DOI: 10.1177/107602969700300212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We studied the relationship between activated protein C (APC) resistance and the central venous devices (CVD)-related complications in 61 cancer patients (44 females `and 17 males, median age 50 years, 71 CVD) from November 1994 to November 1995. Two patients (3.3%) had APC resistance, i.e., APC ratio < 2. Twelve episodes of bactercmia, 8 site infections, 31 cases of CVD dysfunction requiring urokinase (UK), and 3 CVD-retated thromboses were noted. With Cox's proportional hazard models, low APC ratios and high d-dimer levels were significantly associated with CVD-related bacteremia (p = 0.0207 and 0.0210). Such an association was not observed with site infection and CVD dysfunction. The incidence of thrombosis was too low to be analyzed. However, one patient with APC resistance developed subclavian vein thrombosis, leading to eventual removal of the catheter. The prevalence of APC resistance in cancer patients and its association with bacteremia are discussed. Key Words : Activated protein C resistance—Central venous catheters—Bacteremia— Catheter site infection—Thrombosis.
Collapse
Affiliation(s)
- Yi-Kong Keung
- Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Everardo Cobos
- Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Annabel Barber
- Department of Surgery; Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Cathy Ronaghan
- Department of Surgery; Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Robert Whitehead
- Division of Oncology/Hematology, Department of Internal Medicine; Texas Tech University Health Sciences Center, Lubbock, Texas
| | | | - Mary Gilbert
- Clinical Laboratory, University. Medical Center, Lubbock, Texas, U.S.A
| | - David Morgan
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| |
Collapse
|
26
|
Mortality and Causes of Death in Families With the Factor V Leiden Mutation (Resistance to Activated Protein C). Blood 1997. [DOI: 10.1182/blood.v89.6.1963] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractTo investigate whether resistance to activated protein C (APC resistance) because of a mutation in the factor V gene (factor V Leiden) leads to a decrease in life expectancy, we analyzed overall and cause-specific mortality in 171 parents whose offspring carried this mutation. Compared with the Dutch general population, and after adjustment for age, sex, and calendar period, we found no excess deaths in the parents (standardized mortality ratio [SMR], 1.0; 95% confidence interval [CI], 0.8 to 1.2). The cause-specific SMR for malignant neoplasms (1.0; 95% CI, 0.6 to 1.4), diseases of the circulatory system (1.0; 95% CI, 0.7 to 1.4), and cerebrovascular disease (1.0; 95% CI, 0.4 to 1.9) also did not differ from unity. The SMRs for diseases of the respiratory system (1.4; 95% CI, 0.6 to 2.6) and for ischemic heart diseases (1.1; 95% CI, 0.7 to 1.7) were slightly increased. Under the age of 45 years, there was a ninefold increase of dying from ischemic heart disease. Thromboembolic complications were mentioned only once (venous embolism or thrombosis) as an underlying (“primary”) cause of death (SMR, 2.3; 95% CI, 0.1 to 13.0) and three times (pulmonary embolisms) as a contributing (“secondary”) cause of death (SMR, 1.5; 95% CI, 0.3 to 4.4). We conclude that there is no major effect of APC resistance on life expectancy. Therefore, long-term anticoagulation in carriers of factor V Leiden, on the basis of the carrier state alone, is not indicated.
Collapse
|
27
|
Bontempo FA, Hassett AC, Faruki H, Steed DL, Webster MW, Makaroun MS. The factor V Leiden mutation: spectrum of thrombotic events and laboratory evaluation. J Vasc Surg 1997; 25:271-5; discussion 276. [PMID: 9052561 DOI: 10.1016/s0741-5214(97)70348-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aims to describe the spectrum of clinical thrombotic events and to compare the methods of laboratory evaluation for the newly described prothrombotic factor V Leiden mutation. METHODS Specimens from 1376 patients with thrombotic events or their relatives were tested for the factor V Leiden mutation by polymerase chain reaction plus restriction digest from Jan. 1, 1995, to Mar. 31, 1996. Activated protein C (APC) resistance test data was available for 554 of these patients. Clinical information was available for 166 patients with the mutation. RESULTS Of 1376 patients tested for factor V Leiden mutation, 270 (19.6%) were positive, with 12 homozygotes and 258 heterozygotes. Of 554 patients for whom APC resistance data was available, 221 (39.9%) had low APC resistance ratios (< or = 2.4); of these only 97 (43.9%) were factor V Leiden-positive. Among 333 samples with normal or elevated APC resistance ratios, 19 (5.7%) were later identified with the factor V Leiden mutation, despite the normal screening test. One hundred fourteen of 166 patients (68.7%) with the mutation had at least one thrombotic event, most commonly deep venous thrombosis and pulmonary embolus. Arterial cerebrovascular thrombotic events occurred in 11 patients (10%), and myocardial infarctions in eight (7%). The mean age of all patients with arterial thrombotic events was 45.4 years. CONCLUSIONS The factor V mutation is a common cause of venous thromboses but may also be associated with the early presentation of arterial thrombotic events. The APC resistance test is a sensitive screening assay but has limitations of its specificity in clinical practice.
Collapse
Affiliation(s)
- F A Bontempo
- Division of Hematology, University of Pittsburgh School of Medicine, PA 15213, USA
| | | | | | | | | | | |
Collapse
|
28
|
Lindoff C, Ingemarsson I, Martinsson G, Segelmark M, Thysell H, Astedt B. Preeclampsia is associated with a reduced response to activated protein C. Am J Obstet Gynecol 1997; 176:457-60. [PMID: 9065198 DOI: 10.1016/s0002-9378(97)70515-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Resistance to activated protein C is an inherited mutation of the coagulation factor V gene, a major factor predisposing to thromboembolic events. The purpose of this study was to investigate the occurrence of heterozygote and homozygote activated protein C resistance in women with preeclampsia. STUDY DESIGN Activated protein C resistance and protein C and antithrombin III levels were determined in women (n = 50) with a history of preeclampsia and in controls (50 women with a previous normal pregnancy). The mutation of the factor V gene was analyzed. RESULTS Activated protein C resistance was found in 22% of women with previous preeclampsia compared with 10% among controls. Two women in the previous preeclampsia group had a homozygote mutation of factor V; the others were heterozygous. There was a significant difference in the activated protein C ratio between women with previous preeclampsia and the control group, 2.6 +/- 0.4 versus 3.1 +/- 0.5 (p = 0.04). None of the women had protein C or antithrombin III deficiency. CONCLUSION The results indicate that activated protein C resistance may be a contributory factor in the pathogenesis of preeclampsia.
Collapse
Affiliation(s)
- C Lindoff
- Department of Obstetrics and Gynecology, University of Lund, University Hospital, Sweden
| | | | | | | | | | | |
Collapse
|
29
|
Zöller B, Hillarp A, Berntorp E, Dahlbäck B. Activated protein C resistance due to a common factor V gene mutation is a major risk factor for venous thrombosis. Annu Rev Med 1997; 48:45-58. [PMID: 9046944 DOI: 10.1146/annurev.med.48.1.45] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Inherited resistance to activated protein C (APC) was recently discovered to be a cause of familial thrombophilia and is now known to be the most common genetic risk factor for venous thrombosis. It is caused by a single point mutation in the gene for factor V, which predicts substitution or arginine (R) at position 506 with a glutamine (Q). Accordingly, the activated form of mutated factor V (FVa:Q506) is more slowly degraded by activated protein C than normal FVa (FVa:R506) is, resulting in hypercoagulability and a lifelong 5- to 10-fold increased risk of venous thrombosis. Previously known inherited hypercoagulable states, i.e. deficiencies of the anticoagulant proteins antithrombin III, protein S, and protein C, are found fewer than 10-15% of thrombosis patients in western countries, whereas inherited APC resistance is present in 20-60% of such patients. The FV mutation is common in populations of Caucasian origin, with prevalences ranging from 1-15%, whereas it is not found in certain other ethnic groups such as Japanese and Chinese. The high prevalence of APC resistance, in combination with the availability of simple laboratory tests, will have a profound influence on the development of therapeutic and prophylactic regimens for thrombosis and will, it is hoped, result in a decreased incidence of thromboembolic events.
Collapse
Affiliation(s)
- B Zöller
- Department of Clinical Chemistry, Lund University, University Hospital, Malmö, Sweden
| | | | | | | |
Collapse
|
30
|
Bernard P, Giraud P, Drouet A, Ribot C. [Cerebral arterial infarction in young adults and resistance to activated protein C]. Rev Med Interne 1996; 17:950. [PMID: 8977980 DOI: 10.1016/0248-8663(96)88129-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
31
|
Sakata T, Kario K, Katayama Y, Matsuyama T, Kato H, Miyata T. Clinical significance of activated protein C resistance as a potential marker for hypercoagulable state. Thromb Res 1996; 82:235-44. [PMID: 8732627 DOI: 10.1016/0049-3848(96)00070-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The activated protein C (APC)-resistance test is a simple and reliable method for detecting reduced sensitivity to the anticoagulant action of this protein. We investigated the sensitivity to APC in 180 Japanese controls and in 96 Japanese patients with venous and arterial thrombosis (28 with deep vein thrombosis; 13 with pulmonary thromboembolism; 41 with cerebral infarction; and 14 with coronary artery disease). All of the patient groups showed significantly reduced sensitivity to APC, reflected by the lower normalized APC-sensitivity ratio (n-APC-SR), as compared with healthy control. The APC-sensitivity ratio was negatively correlated with plasma activated factor VII levels. These results suggest that the low n-APC-SR is related to venous or arterial thrombotic disease. The APC resistance may serve as a potential marker for assessing the hypercoagulable state.
Collapse
Affiliation(s)
- T Sakata
- Laboratory of Clinical Chemistry, National Cardiovascular Center, Osaka, Japan
| | | | | | | | | | | |
Collapse
|
32
|
Ballering LA, Bon MA, Steffens-Nakken HM, van den Bergh FA. Chemiluminescent detection of factor V Leiden in a routine laboratory. Ann Clin Biochem 1996; 33 ( Pt 3):259-62. [PMID: 8791992 DOI: 10.1177/000456329603300315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- L A Ballering
- Hospital Medisch Spectrum Twente, Department of Clinical Chemistry, Enschede, The Netherlands
| | | | | | | |
Collapse
|
33
|
Mandel H, Brenner B, Berant M, Rosenberg N, Lanir N, Jakobs C, Fowler B, Seligsohn U. Coexistence of hereditary homocystinuria and factor V Leiden--effect on thrombosis. N Engl J Med 1996; 334:763-8. [PMID: 8592550 DOI: 10.1056/nejm199603213341204] [Citation(s) in RCA: 191] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Venous and arterial thromboembolism occurs in only about one third of patients homozygous for homocystinuria, which suggests that other, contributory factors are necessary for the development of thrombosis in these patients. Factor V Leiden, an R506Q mutation in the gene coding for factor V, is the most common cause of familial thrombosis and could be a potentiating factor. METHODS We determined activated partial-thromboplastin times in the presence and absence of activated protein C and tested for the factor V Leiden mutation in 45 members of seven unrelated consanguineous kindreds in which at least 1 member was homozygous for homocystinuria. RESULT Thrombosis (venous, arterial, or both) occurred in 6 of 11 patients with homocystinuria (age, 0.2 to 8 years). All six also had the factor V Leiden mutation. One patient with prenatally diagnosed homocystinuria who was also heterozygous for factor V Leiden has received warfarin therapy since birth and has not had thrombosis (age, 18 months). Of four patients with homocystinuria who did not have factor V Leiden, none had thrombosis (ages at this writing, 1 to 17 years). Three women who were heterozygous for both homocystinuria and factor V Leiden had recurrent fetal loss and placental infarctions. CONCLUSIONS Patients with concurrent homocystinuria and factor V Leiden can have an increased risk of thrombosis. Screening for factor V Leiden may be indicated in patient with homocystinuria and their family members.
Collapse
Affiliation(s)
- H Mandel
- Department of Pediatrics, Rambam Medical Center, Haifa, Israel
| | | | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Larsson J, Olafsdottir E, Bauer B. Activated protein C resistance in young adults with central retinal vein occlusion. Br J Ophthalmol 1996; 80:200-2. [PMID: 8703855 PMCID: PMC505428 DOI: 10.1136/bjo.80.3.200] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Central retinal vein occlusion is a disease that is most common in old people. While the disease in old people often is associated with atherosclerosis, hypertension, diabetes, or glaucoma, this is much less evident in young people. However, a new defect in the anticoagulant system has recently been discovered, activated protein C resistance. This hereditary defect may well be associated with central retinal vein occlusion, and so this factor was analysed in patients younger than 50 years with a history of central retinal vein occlusion. METHODS Blood samples were obtained from 31 patients younger than 50 years with a history of central retinal vein occlusion, and analysed for activated protein C resistance with standard clinical laboratory methods. RESULTS In this material 26% of all the patients and 36% of the patients younger than 45 years were resistant to activated protein C. The normal incidence of activated protein C resistance is 2-7%. CONCLUSION Activated protein C resistance seems to be the most common known cause of central retinal vein occlusion in young people.
Collapse
Affiliation(s)
- J Larsson
- Department of Ophthalmology, Lund University Hospital, Sweden
| | | | | |
Collapse
|
36
|
Emmerich J, Alhenc-Gelas M, Aiach M, Fiessinger JN. Resistance to activated protein C: role in venous and arterial thrombosis. Biomed Pharmacother 1996; 50:254-60. [PMID: 8952864 DOI: 10.1016/0753-3322(96)84822-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Activated protein C resistance is the most prevalent cause of thrombophilia: it is found in 20 to 30% of patients with a deep venous thrombosis history. Activated protein C resistance is due to an arginine 506 to glutamine mutation in factor V. This mutation prevents normal inactivation of activated factor V by activated protein C. The estimated increase in relative risk of venous thrombosis is 5- to 10-fold in heterozygotes, and 50- to 100-fold in homozygotes. Activated protein C resistance does not seem to play a role in arterial thrombosis and in the occurrence of myocardial infarction.
Collapse
Affiliation(s)
- J Emmerich
- Service de Médecine Vasculaire, Centre Claude Bernard de Recherche sur les Maladies Vasculaires Périphériques, Hôpital Broussais, Paris, France
| | | | | | | |
Collapse
|
37
|
Zöller B. Familial thrombophilia: clinical and molecular analysis of Swedish families with inherited resistance to activated protein C or protein S deficiency. Scand J Clin Lab Invest Suppl 1996; 226:19-46. [PMID: 8981666 DOI: 10.1080/00365519609168297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This report describes the characterization of Swedish families with inherited resistance to activated protein C (APC resistance) and/or protein S deficiency, two genetic disorders associated with functional impairment of the protein C anticoagulant pathway. The APC resistance phenotype was linked to the factor V gene locus in a kindred with independent inheritance of APC resistance and protein S deficiency. A point mutation changing Arg506 to a Gln (FV:Q506) in the factor V gene was the cause of APC resistance. In studies of 50 families with hereditary APC resistance, the FV:Q506 mutation was identified in 94% (47/50) of the families, and the thrombotic risk was found to be dependent on the factor V genotype. Moreover, 18 families with hereditary deficiency of free protein S were investigated. Type I protein S deficiency (low free and total protein S) and type III deficiency (low free but normal total protein S) coexisted in 78% (14/18) of the families, suggesting the two types to be phenotypic variants of the same genetic disorder. Deficiency of free protein S was caused by equimolar relationship between protein S and beta-chain containing isoforms of C4BP. Though protein S deficiency was a strong risk factor for thrombosis, the FV:Q506 mutation was identified as an additional genetic risk factor in 39% of the families. Thus, familial thrombophilia is a multiple gene disorder. The thrombophilic tendency associated with APC resistance or protein S deficiency was related to increased levels of prothrombin fragment 1 + 2, reflecting increased activation of the common coagulation pathway.
Collapse
Affiliation(s)
- B Zöller
- Department of Clinical Chemistry, Lund University, University Hospital, Malmö, Sweden
| |
Collapse
|
38
|
Ouriel K, Green RM, DeWeese JA, Cimino C. Activated protein C resistance: prevalence and implications in peripheral vascular disease. J Vasc Surg 1996; 23:46-51, Discussion 51-2. [PMID: 8558741 DOI: 10.1016/s0741-5214(05)80034-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Activated protein C (APC) is a naturally occurring anticoagulant that interacts with factors V and VIII to inhibit the clotting cascade. Resistance to APC (APC-R), hypothesized to occur as a result of an abnormal factor V, has been documented in up to 40% of patients with venous thrombotic events, but its prevalence in patients with arterial disease remains ill defined. METHODS With an assay of APC resistance that expresses the ratio of the activated partial thromboplastin time with and without the addition of exogenous APC, APC resistance ratios were quantitated in 200 individuals comprising 177 patients with vascular disease and 23 control subjects. An abnormal activated partial thromboplastin time was present in four patients who were excluded from analysis. The 173 remaining patients formed the study population and were divided into diagnostic subgroups on the basis of the most symptomatic problem. RESULTS APC resistance was documented in 20 individuals, representing 11.6% of the study group. The highest prevalence of APC resistance was observed in patients with lower extremity occlusive disease, with the APC-R ratio below 2.0 in 13.7%. Within the subgroup of individuals with lower extremity disease, 76 patients (10 with APC-R, 13.2%) underwent infrainguinal bypass and were monitored a mean of 47 +/- 8 months. Occlusion of the arterial reconstruction occurred in 22 patients (29%). Six (60%) of the patients with APC-R had failed reconstructions, versus 16 (24%) of 66 patients without APC-R (p = 0.02). CONCLUSIONS These findings suggest that APC-R is relatively common in patients with peripheral vascular disease, especially in those with lower extremity occlusive disease. APC-R appears to be a risk factor for failure of infrainguinal bypass. These observations suggest that screening for APC-R may be useful in patients with peripheral vascular disease, providing the opportunity to restore the normal thrombogenic balance with anticoagulant therapy in susceptible individuals.
Collapse
Affiliation(s)
- K Ouriel
- Department of Surgery, University of Rochester, NY 14642, USA
| | | | | | | |
Collapse
|
39
|
Press RD, Liu XY, Beamer N, Coull BM. Ischemic stroke in the elderly. Role of the common factor V mutation causing resistance to activated protein C. Stroke 1996; 27:44-8. [PMID: 8553401 DOI: 10.1161/01.str.27.1.44] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE A common missense mutation in coagulation factor V (Arg 506 Gln) creates phenotypic resistance to the anticoagulant effects of activated protein C and predisposes carriers to venous thrombosis. To assess a correlation between this common hypercoagulable state and ischemic cerebrovascular disease, we have compared the prevalence of this mutation in a group of stroke patients with that in several control patient groups. METHODS The presence of the factor V Arg 506 Gln mutation was determined by a direct polymerase chain reaction-based assay on peripheral blood leukocytes from 161 elderly patients with acute ischemic stroke, 116 elderly patients with stroke risk factors but without acute stroke, 54 healthy elderly control subjects, and 287 younger control individuals (197 blood donors and 90 neonates). RESULTS The prevalence of the heterozygous Arg 506 Gln factor V mutation was not significantly different in the elderly stroke patients (2.5%) compared with either of the age-matched control groups (2% to 4%). The prevalence of this mutation was significantly higher in each of two younger control groups (approximately 8%) than in the elderly stroke patients (2.5%). CONCLUSIONS The common factor V Arg 506 Gln mutation predisposing to venous thrombosis is not a significant genetic risk factor for ischemic stroke in the elderly.
Collapse
Affiliation(s)
- R D Press
- Department of Pathology, Oregon Health Sciences University, Portland 97201-3098, USA
| | | | | | | |
Collapse
|
40
|
Simioni P, de Ronde H, Prandoni P, Saladini M, Bertina RM, Girolami A. Ischemic stroke in young patients with activated protein C resistance. A report of three cases belonging to three different kindreds. Stroke 1995; 26:885-90. [PMID: 7740584 DOI: 10.1161/01.str.26.5.885] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND A new pathological condition termed "activated protein C (APC) resistance" has recently been reported to be the most common hereditary blood coagulation disorder associated with familial thrombosis. APC resistance is characterized by a poor anticoagulant response to APC in the plasma of patients and is due to a defect of factor V. CASE DESCRIPTIONS This report deals with three Italian families with inherited APC resistance in which stroke had occurred at a young age in one of the family members. One of the patients exhibited ischemic stroke at 8 months of age. Although deep vein thrombosis is considered the main clinical manifestation of the defect, its possible association with stroke is discussed. DNA analysis confirmed the presence of the 1691GA mutation in the factor V gene (factor V Leiden) in all patients with a normalized APC sensitivity ratio of less than 0.70. In three cases the APC sensitivity ratios were very low (approximately 1.2), with a normalized APC sensitivity ratio of approximately 0.4. DNA analysis confirmed that these patients were homozygous for the mutation. The clinical history of these patients suggests that homozygosity for the defect is compatible with life and does not seem to be associated with early or more severe thrombophilia compared with homozygous defects of other clotting inhibitors. CONCLUSIONS The cases reported here suggest a possible association of inherited APC resistance with ischemic stroke in young patients. Case-control studies should be performed to assess the true association.
Collapse
Affiliation(s)
- P Simioni
- Institute of Medical Semeiotics, University of Padua Medical School, Italy
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Venous thrombosis is often familial, but until recently well-defined genetic defects were only found in a minority of patients. The situation changed with the discovery of inherited resistance to activated protein C (APC) as a novel mechanism for familial thrombophilia. It is caused by a single point mutation in the factor V gene, which predicts replacement of Arg506 in the APC-cleavage site with a Gln. APC resistance is found in a majority of patients with familial thrombosis as well as in 3-7% of the general population. It afflicts affected individuals with a life-long increased risk of thrombosis. The factor V gene mutation is the most prevalent single gene defect associated with thromboembolic disease so far described.
Collapse
Affiliation(s)
- B Dahlbäck
- Department of Clinical Chemistry, University of Lund, Malmö General Hospital, Sweden
| |
Collapse
|
42
|
Dahlbäck B. Factor V gene mutation causing inherited resistance to activated protein C as a basis for venous thromboembolism. J Intern Med 1995; 237:221-7. [PMID: 7891043 DOI: 10.1111/j.1365-2796.1995.tb01170.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Venous thromboembolism is often familial, suggesting that genetic risk factors are involved. Until recently, genetic defects known to predispose for thrombosis (deficiencies of antithrombin III, protein C, and protein S) had not been shown to account for more than 5-10% of the cases. Inherited resistance to the anticoagulant function of activated protein C (APC) in the last year has been identified as a major basis for familial thrombosis. Unlike other genetic risk factors for thrombosis, APC resistance is highly prevalent in the general population (2-5%). In more than 90% of cases, the APC-resistance phenotype is associated with a point mutation in the factor V gene, which predicts replacement of arginine at position 506 with a glutamine. As APC inhibits factor Va by cleavage at arginine 506, mutated factor V is resistant to APC. In its heterozygous state, the mutation is associated with a 5-10-fold increased risk of thrombosis. Homozygocity is associated with more severe APC resistance, and with a higher risk of thrombosis. Because of its high prevalence in the population, individuals with deficiencies of other anticoagulant proteins occasionally carry the factor V gene mutation. People with such combinations of mutations have a higher risk of thrombosis than those with the single mutations. In conclusion, in the majority of familial thrombosis cases it is now possible to identify an underlying genetic risk factor. APC resistance caused by a single, factor V gene mutation, is the most frequent risk factor and it is at least ten times more common than any of the other genetic defects associated with thrombosis.
Collapse
Affiliation(s)
- B Dahlbäck
- Department of Clinical Chemistry, University of Lund, Malmö General Hospital, Sweden
| |
Collapse
|
43
|
Affiliation(s)
- B Dahlbäck
- Department of Clinical Chemistry, University of Lund, Malmö General Hospital, Sweden
| |
Collapse
|
44
|
Zöller B, Svensson PJ, He X, Dahlbäck B. Identification of the same factor V gene mutation in 47 out of 50 thrombosis-prone families with inherited resistance to activated protein C. J Clin Invest 1994; 94:2521-4. [PMID: 7989612 PMCID: PMC330087 DOI: 10.1172/jci117623] [Citation(s) in RCA: 281] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Resistance to activated protein C (APC) is the most prevalent inherited cause of venous thrombosis. The APC resistance phenotype is associated with a single point mutation in the factor V gene, changing Arg506 in the APC cleavage site to a Gln. We have investigated 50 Swedish families with inherited APC resistance for this mutation and found it to be present in 47 of them. Perfect cosegregation between a low APC ratio and the presence of mutation was seen in 40 families. In seven families, the co-segregation was not perfect as 12 out of 57 APC-resistant family members were found to lack the mutation. Moreover, in three families with APC resistance, the factor V gene mutation was not found, suggesting another still unidentified cause of inherited APC resistance. Of 308 investigated families members, 146 were normal, 144 heterozygotes, and 18 homozygotes for the factor V gene mutation and there were significant differences in thrombosis-free survival curves between these groups. By age 33 yr, 8% of normals, 20% of heterozygotes, and 40% of homozygotes had had manifestation of venous thrombosis.
Collapse
Affiliation(s)
- B Zöller
- Department of Clinical Chemistry, University of Lund, Malmö General Hospital, Sweden
| | | | | | | |
Collapse
|
45
|
Dahlbäck B. Physiological anticoagulation. Resistance to activated protein C and venous thromboembolism. J Clin Invest 1994; 94:923-7. [PMID: 8083377 PMCID: PMC295127 DOI: 10.1172/jci117458] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- B Dahlbäck
- Department of Clinical Chemistry, University of Lund, Malmö General Hospital, Sweden
| |
Collapse
|