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Systematic Review and Meta-Analysis of the Susceptibility of ABO Blood Groups to Venous Thromboembolism in Individuals with Factor V Leiden. Diagnostics (Basel) 2022; 12:diagnostics12081936. [PMID: 36010287 PMCID: PMC9406524 DOI: 10.3390/diagnostics12081936] [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: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
A limited number of studies investigated the association between the ABO blood groups and the incidence of venous thromboembolism in individuals with Factor V Leiden; however, discordant findings were reported. Consequently, this systematic review and meta-analysis aimed to evaluate the existing evidence on the susceptibility of the ABO blood group to venous thromboembolism in individuals with Factor V Leiden. All English-published articles on the Web of Science, Scopus, PubMed, EMBASE, and Google Scholar were comprehensively and systematically searched by the author without a time or region limit. Four studies were included in the qualitative synthesis and meta-analysis after the removal of studies that were not eligible. According to the analyses of the fixed and random effects, the point estimates of the effect size and the 95% confidence interval were 0.416 (95% CI: 0.397−0.435) and 0.392 (95% CI: 0.288−0.507), respectively. In contrast, the homogeneity test (Q value) reveals that blood group data distributions have a heterogenous structure (Q = 432.187; p-value < 0.001). The pooled event rates and the 95% CIs for the A, AB, B, and O-blood groups were 0.518 (95% CI: 0.411−0.622), 0.592 (95% CI: 0.495−0.683), 0.205 (95% CI: 0.041−0.612), and 0.283 (95% CI: 0.247−0.322), respectively. According to the findings, people with Factor V Leiden with blood group AB are more likely to develop venous thromboembolism than those with blood groups A, O, and B. The overall statistical significance of the ABO blood group’s susceptibility to venous thromboembolism in individuals with Factor V Leiden was <0.001 (pooled p-value). In conclusion, the current meta-analysis provides an additional indication that blood group AB individuals with Factor V Leiden are at higher risk of developing venous thromboembolism, and blood type B is connected to a lower risk of developing venous thromboembolism.
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Kimelfeld EI, Koltsova EA, Petrova EA, Gudkova VV, Stahovskaya LV, Tupitsyna TV, Bondarenko EA, Slominsky PA, Limborska SA. [The association of hemostasis system genes with the development of ischemic stroke in patients under the age of 50 years]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:14-21. [PMID: 30499554 DOI: 10.17116/jnevro201811809214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study an influence of polymorphic variants of hemostasis system genes on the risk of ischemic stroke (IS) in patients of the Slavic population under the age of 50 years. MATERIAL AND METHODS Ninety-two patients (19 women and 73 men), aged 18-50 years, were examined. The diagnosis of stroke was confirmed by neuroimaging (CT or MRI) in all patients. Polymorphic alleles of GP1BA, F2, F5 were studied by a real-time polymerase chain reaction using the TaqMan technology. RESULTS AND CONCLUSION An analysis of the GP1BA -5T/C polymorphism showed that it was associated with IS in young men, lacunar stroke and stroke due to thrombosis of the brachiocephalic arteries. This association was not found in young women. The F5 G1691A polymorphism was associated with lacunar stroke. The F2 G20210A polymorphism was associated with stroke due to thrombosis of the brachiocephalic arteries.
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Affiliation(s)
- E I Kimelfeld
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Koltsova
- Pirogov Russian National Research Medical University, Moscow, Russia; Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Petrova
- Pirogov Russian National Research Medical University, Moscow, Russia; Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Moscow, Russia
| | - V V Gudkova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Stahovskaya
- Pirogov Russian National Research Medical University, Moscow, Russia; Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Moscow, Russia
| | - T V Tupitsyna
- Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
| | - E A Bondarenko
- Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
| | - P A Slominsky
- Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Moscow, Russia; Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
| | - S A Limborska
- Research Institute of Cerebrovascular Pathology and Stroke, Pirogov Russian National Research Medical University, Moscow, Russia; Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
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Brummel-Ziedins KE, Gissel M, Neuhaus J, Borges ÁH, Chadwick DR, Emery S, Neaton JD, Tracy RP, Baker JV. In silico thrombin generation: Plasma composition imbalance and mortality in human immunodeficiency virus. Res Pract Thromb Haemost 2018; 2:708-717. [PMID: 30349890 PMCID: PMC6178732 DOI: 10.1002/rth2.12147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 07/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Effective HIV treatment with antiretroviral therapy has prolonged survival and shifted causes of death to non-AIDS illnesses such as cardiovascular disease. We have shown that inflammation and HIV viral load associate with pro- and anticoagulant factor imbalances resulting in increased thrombin generation when mathematically modeled. We explore the hypothesis that factor compositional imbalance, corresponding to increased in silico thrombin generation, predicts mortality among HIV+ persons. Methods In a nested case-control study of HIV+ individuals on continuous antiretroviral therapy in two large trials, we evaluated cases (any non-violent mortality, n = 114) and matched controls (n = 318). Thrombin generation in response to a tissue-factor initiator for each individual was calculated by a mathematical model incorporating levels of factors (F)II, V, VII, VIII, IX, X, antithrombin, tissue factor pathway inhibitor, and protein C (PC) measured at study entry to the trials. In silico thrombin generation metrics included clot time, maximum rate (MaxR), maximum level (MaxL), and area under the curve (AUC). Results Levels of antithrombin and PC decreased, while FV and FVIII were higher in cases vs controls. This resulted in a more procoagulant phenotype with increased MaxR, MaxL, and AUC in cases compared to controls (P < 0.05 for all). Conclusions Antithrombin, FV, FVIII, and PC were the major contributors to the increased thrombin generation associated with mortality risk. Our results suggest that mortality in HIV is associated with an increase in in silico thrombin generation via altered balance of pro- and anticoagulant factors, likely due to an inflammatory response signal, and resulting coagulopathy.
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Affiliation(s)
| | - Matthew Gissel
- Department of Biochemistry University of Vermont Colchester Vermont USA
| | - Jacqueline Neuhaus
- Department of Biostatistics University of Minnesota Minneapolis Minnesota USA
| | - Álvaro H Borges
- Centre of Excellence for Health, Immunity, and Infections (CHIP) Department of Infectious Diseases, Rigshospitalet University of Copenhagen Copenhagen Denmark.,Institute for Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Sean Emery
- Faculty of Medicine University of Queensland Brisbane Australia.,The Kirby Institute University of New South Wales Sydney Australia
| | - James D Neaton
- Department of Biostatistics University of Minnesota Minneapolis Minnesota USA
| | - Russell P Tracy
- Department of Biochemistry University of Vermont Colchester Vermont USA.,Department of Pathology and Laboratory Medicine University of Vermont Burlington Vermont USA
| | - Jason V Baker
- Department of Medicine University of Minnesota Minneapolis Minnesota USA.,Department of Infectious Diseases Hennepin County Medical Center Minneapolis Minnesota USA
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Prothrombin G20210A (rs1799963) polymorphism increases myocardial infarction risk in an age-related manner: A systematic review and meta-analysis. Sci Rep 2017; 7:13550. [PMID: 29051591 PMCID: PMC5648836 DOI: 10.1038/s41598-017-13623-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/27/2017] [Indexed: 01/11/2023] Open
Abstract
G20210A polymorphism (rs1799963) within the prothrombin gene is associated with a higher circulation level of prothrombin, thus increasing the likelihood of developing myocardial infarction (MI). Opinions differ regarding the correlation between prothrombin G20210A genotype and MI risk, which prompted us to conduct a meta-analysis to determine this association. PubMed, EMBASE, Web of Science and CNKI were searched for pertinent reports. A total of 34 studies involving 14 611 MI cases and 84 358 controls were analyzed in this quantitative analysis. We found a statistically significant association between prothrombin G20210A polymorphism and MI in the allele model (A vs. G, OR = 1.43, 95%CI: 1.18–1.72), heterozygote model (GA vs. GG, OR = 1.41, 95%CI: 1.16–1.72) and dominant model (GA + AA vs. GG, OR = 1.41, 95%CI: 1.15–1.72). The association remains significant in Caucasians but not in non-Caucasians. Moreover, prothrombin G20210A polymorphism increases MI risk in an age-related manner. A further significant association was found in a subpopulation younger than 55 years (allele model, OR = 1.76, 95%CI: 1.32–2.35; heterozygote model, OR = 1.70, 95%CI: 1.24–2.33; dominant model, OR = 1.70, 95%CI: 1.24–2.34). Sensitivity analysis and publication bias analysis revealed stable and statistically robust results. Our meta-analysis demonstrated that prothrombin G20210A polymorphism may represent a risk factor for MI.
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An Unexpectedly High Rate of Thrombophilia Disorders in Patients with Superficial Vein Thrombosis of the Lower Extremities. Ann Vasc Surg 2017; 43:272-277. [PMID: 28501666 DOI: 10.1016/j.avsg.2017.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/19/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Superficial vein thrombosis (SVT) is a common venous condition. Recent studies have shown that SVT is associated with high frequency of thromboembolic complications: from 22-37% for deep venous thrombosis and up to 33% for pulmonary embolism. Our goal was to assess the prevalence of major hereditary and acquired thrombophilic factors in patients with SVT. METHODS Sixty-six patients presenting with primary SVT underwent evaluation for thrombophilia: molecular testing for the factor V Leiden and factor II G20210 A (prothrombin) mutations, protein C, protein S, antithrombin deficiency, presence of lupus anticoagulant, as well as anticardiolipin antibody titers. Patients aged less than 18 years, with confirmed deep vein thrombosis, and pregnant women were excluded. RESULTS 95.5% were Caucasian, and 62.1% were female gender. Age ranged from 21-88 years. Molecular testing showed that 34.2% of patients were heterozygous for factor V Leiden, 23.6% were heterozygous for the factor II mutation, 7.8% had antithrombin deficiency, 2.6% had protein S deficiency, and 2.1% had protein C deficiency. CONCLUSIONS Our study showed that hereditary and acquired thrombophilias are higher than previously expected and reported.
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Hmimech W, Idrissi HH, Diakite B, Baghdadi D, Korchi F, Habbal R, Nadifi S. Association of C677T MTHFR and G20210A FII prothrombin polymorphisms with susceptibility to myocardial infarction. Biomed Rep 2016; 5:361-366. [PMID: 27588178 DOI: 10.3892/br.2016.717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/19/2016] [Indexed: 11/05/2022] Open
Abstract
Myocardial infarction (MI) is a common complex pathology, localized in the main leading causes of mortality worldwide. It is the result of the interaction of genetic and environmental factors. The aim of the present study was to investigate the potential association of C677T 5,10-methylenetetrahydrofolate reductase (MTHFR) (rs1801133) and G20210A factor II prothrombin (FII) (rs1799963) polymorphisms with the susceptibility of MI. Following extraction by the standard salting-out procedure, DNA samples of 100 MI patients and 182 apparently healthy controls were genotyped by polymerase chain reaction-restriction fragment length polymorphism using HinfI and HindIII restriction enzymes, respectively. The results show a significant association of the G20210T FII polymorphism with the MI risk. The frequencies of the heterozygote genotype GA, homozygous mutated AA and the G20210A allele was higher among patients compared to controls (GA: 59 vs. 5.5%, P<0.001; AA: 10 vs. 0%, P=0.003; and 20210A: 39.5 vs. 2.7%, P<0.003), suggesting that this polymorphism may be a potential genetic marker for MI. No significant association was observed between the C677T MTHFR and MI occurrence, and there was more heterozygote CT in the patient group compared to the controls. As a multifactorial disease, the development of MI may be the result of numerous factors that influence synergistically its occurrence. Thus, further studies are merited to try to better assess these associations (gene-gene and gene-environment interactions).
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Affiliation(s)
- Wiam Hmimech
- Laboratory of Genetics and Molecular Pathology, Medical School, University Hassan II, Casablanca BP 9154, Morocco
| | - Hind Hassani Idrissi
- Laboratory of Genetics and Molecular Pathology, Medical School, University Hassan II, Casablanca BP 9154, Morocco
| | - Brehima Diakite
- Laboratory of Genetics and Molecular Pathology, Medical School, University Hassan II, Casablanca BP 9154, Morocco
| | - Dalila Baghdadi
- Department of Cardiology, Ibn Rochd University Hospital Center, Casablanca 20102, Morocco
| | - Farah Korchi
- Department of Cardiology, Ibn Rochd University Hospital Center, Casablanca 20102, Morocco
| | - Rachida Habbal
- Department of Cardiology, Ibn Rochd University Hospital Center, Casablanca 20102, Morocco
| | - Sellama Nadifi
- Laboratory of Genetics and Molecular Pathology, Medical School, University Hassan II, Casablanca BP 9154, Morocco
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Kallel A, Sbaï MH, Sédiri Y, Feki M, Mourali MS, Mechmeche R, Jemaa R, Kaabachi N. Association Between the G20210A Polymorphism of Prothrombin Gene and Myocardial Infarction in Tunisian Population. Biochem Genet 2016; 54:653-64. [PMID: 27306359 DOI: 10.1007/s10528-016-9744-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/27/2016] [Indexed: 01/20/2023]
Abstract
The prothrombin is the precursor of the serine protease thrombin, a key enzyme in homeostasis. Prothrombin G20210A polymorphism (rs1799963) was described as a moderate risk factor for venous thrombosis because this mutation is associated with prothrombin elevated levels which may lead to an imbalance between the procoagulant, anticoagulant, and fibrinolytic system. 20210A carriers have an increased risk of thrombosis. In this study, we proposed to determine the prevalence of 20210A prothrombin variant among Tunisian population, and to evaluate the potential relevance of this variant with myocardial infarction. This study included 1290 unrelated Tunisians (1007 male and 283 female) divided in two groups: Four hundred and eighty-seven MI patients (mean age: 52.64 ± 8.98 years) and 803 apparently healthy controls (mean age: 51 ± 8.99). The prothrombin G20210A polymorphism was carried out by polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) analysis. The distribution of genotypes was in accordance with Hardy-Weinberg equilibrium (p > 0.05). A significant difference in genotype distribution and allele frequency was observed between patients and controls. Male patients with MI had a frequency of 97 % for GG genotype and 3 % for GA+AA genotypes. The control group had a frequency of 99 % for the GG genotype and 1 % for the GA+AA genotypes which is significantly lower than the frequency found in patients (p = 0.01). The same genotype frequencies were found in women (p = 0.032). The MI patient group showed a significantly higher frequency of 20210A allele compared to controls 0.02 versus 0.01 [OR = 3.60 (95 % CI = 1.29-10.53), p = 0.005] in men and 0.015 versus 0.068 [OR = 4.68 (95 % CI = 1.60-14.26), p = 0.001] in women. Our work showed a significant but not independent association between the G20210A polymorphism of the prothrombin gene and MI in the Tunisian population.
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Affiliation(s)
- Amani Kallel
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Hedi Sbaï
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Yousra Sédiri
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Moncef Feki
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Rachid Mechmeche
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Riadh Jemaa
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia.
| | - Naziha Kaabachi
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
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Mannhalter C. Biomarkers for arterial and venous thrombotic disorders. Hamostaseologie 2015; 34:115-20, 122-6, 128-30, passim. [PMID: 24819458 DOI: 10.5482/hamo-13-08-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 03/21/2014] [Indexed: 02/06/2023] Open
Abstract
The haemostatic system maintains the blood in a fluid state, but allows rapid clot formation at sites of vascular injury to prevent excessive bleeding. Unbalances within the haemostatic system can lead to thrombosis. Inspite of successful research our understanding of the disease pathogenesis is still incomplete. There is great hope that genetic, genomic, and epigenetic discoveries will enhance the diagnostic capability, and improve the treatment options. During the preceding 20 years, the identification of polymorphisms and the elucidation of their role in arterial and venous thromboses became an important area of research. Today, a large body of data is available regarding associations of single nucleotide polymorphisms (SNPs) in candidate genes with plasma concentrations and e. g. the risk of ischaemic stroke or myocardial infarction. However, the results for individual polymorphisms and genes are often controversial. It is now well established that besides acquired also hereditary risk factors influence the occurrence of thrombotic events, and environmental factors may add to this risk. Currently available statistical methods are only able to identify combined risk genotypes if very large patient collectives (>10,000 cases) are tested, and appropriate algorithms to evaluate the data have yet to be developed. Further research is needed to understand the functional effects of genetic variants in genes of blood coagulation proteins that are critical to the pathogenesis of arterial and venous thrombotic disorders. In this review genetic variants in selected genes of the haemostatic system and their relevance for arterial and venous thrombosis will be discussed.
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Affiliation(s)
- C Mannhalter
- Univ.-Prof. Dr. Christine Mannhalter Dept. Laboratory Medicine, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, Tel. +43/1/404 00 20 85, Fax +43/1/404 00 20 97, E-mail:
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de Campos Guerra JC, Mourão MA, França CN, da Rosa CDP, Burattini MN. Impact of coagulation in the development of thromboembolic events in patients with spinal cord injury. Spinal Cord 2014; 52:327-32. [PMID: 24513719 DOI: 10.1038/sc.2013.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Although the knowledge described about risk factors and venous thromboembolism (VT) in the general population, the impact of these factors in the development of thromboembolic events in patients with spinal injury (SI) caused by spinal cord injury (SCI) is poorly understood. OBJECTIVE Evaluate the impact of risk factors in the development of thromboembolic events in patients with SCI. SETTING Brazil, São Paulo. METHODS Observational, prospective and cross-study. Eligible patients (n=100) had SI by SCI, >18 years. The degree of motor and sensory lesion was evaluated based on American Spinal Injury Association (ASIA) Impairment Scale (AIS). Blood samples were collected for coagulation exams, hemogram, laboratory and biochemical analyses. Ultrasonography analyzes were performed from deep and superficial venous systems of lower limbs. Quantitative real-time PCR experiments were performed in order to investigate mutations in the prothrombin (G20210A) and Leiden factor V (G1691A) genes. RESULTS The main finding of this study was the higher occurrence of deep venous thrombosis (DVT) in patients with Leiden factor V and hyperhomocysteinemia. There was no association between SI for DVT, VT and thrombophilia. Also, there was no relation between lupus anticoagulant and anti-cardiolipin. CONCLUSION There is an important difference in the incidence of DVT in patients with SI by acute and chronic SCI. Therefore, the conduct of the investigation for thrombophilia should be based on clinical factors, risk factors for DVT and family history of thrombosis.
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Affiliation(s)
- J C de Campos Guerra
- 1] Department of Pathology, University of São Paulo, São Paulo, Brazil [2] Department of Clinical Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M A Mourão
- Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - C N França
- 1] Cardiology Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil [2] Santo Amaro University, São Paulo, Brazil
| | - C D P da Rosa
- Institute of Physical Medicine and Rehabilitation, University of São Paulo, São Paulo, Brazil
| | - M N Burattini
- 1] Department of Pathology, University of São Paulo, São Paulo, Brazil [2] Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Simsek E, Yesilyurt A, Pinarli F, Eyerci N, Ulus AT. Combined genetic mutations have remarkable effect on deep venous thrombosis and/or pulmonary embolism occurence. Gene 2013; 536:171-6. [PMID: 24334115 DOI: 10.1016/j.gene.2013.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/26/2013] [Accepted: 11/10/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE Although deep vein thrombosis and thromboembolic diseases differ among various races, they are still important in our day. The difficulties in treatment and following-up of these diseases are caused by secret genetic mutations rather than predisposing factors. METHODS Between January 2011 and May 2013, patients who were traced for deep vein thrombosis and/or pulmonary embolism were evaluated retrospectively. 84 patients (53.6% males and 46.4% females) were included in the study. Their family histories, predisposing factors and treatments were researched. Factor V Leiden (G 1691A), Factor II G20210A, Plasminogen Activator Inhibitor-Type 1 (4G/5G), and Methylene Tetrahydrofolate Reductase (C677T, A1298C) mutations were investigated from peripheral venous blood. RESULTS Among the genetic mutations we searched, the incidence of single mutation rate was observed at 11.9%, double mutation collocation at 44%, triple mutation collocation at 29.8%, quadruple mutation collocation at 13.1%, and finally, quintuplet mutation collocation at 1.2%. Our approximate mutation number was found as 2.47 ± 0.91. CONCLUSION We observed that multiple mutations were high in number compared to single genetic mutations. The patients who have multiple mutations should be more in the front line considering their diagnosis, treatment and following up, and also in terms of decreasing mortality, morbidity and recurrence.
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Affiliation(s)
- Erdal Simsek
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey.
| | - Ahmet Yesilyurt
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Stem Cell and Genetic Diagnostic Center, Diskapi, Ankara, Turkey.
| | - Ferda Pinarli
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Stem Cell and Genetic Diagnostic Center, Diskapi, Ankara, Turkey.
| | - Nilnur Eyerci
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Stem Cell and Genetic Diagnostic Center, Diskapi, Ankara, Turkey.
| | - A Tulga Ulus
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey.
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They-They TP, Battas O, Nadifi S. Synergistic effect of MTHFR C677T and F2 G20210A polymorphisms on ischemic stroke. Neurosci Bull 2013; 29:725-30. [PMID: 24132798 DOI: 10.1007/s12264-013-1381-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 04/01/2013] [Indexed: 11/30/2022] Open
Abstract
The predisposition to stroke might involve interactive effects among variants in several genes. We tested this hypothesis by examining the influence of polymorphisms in methylenetetrahydrofolate reductase (MTHFR) (C677T) and prothrombin (F2) (G20210A) as risk factors for stroke in Morocco. The polymerase chain reaction-restriction fragment length polymorphism methods were used to analyze DNA from 91 stroke patients and 182 controls. Association between the two polymorphisms and the risk of stroke was estimated by four-level models for the analysis of genetic interaction. Neither the MTHFR 677TT nor the F2 20210GA genotype showed any significant association compared to the MTHFR CC and F2 GG genotypes, respectively. An interactive effect between the MTHFR 677TT and F2 20210GA polymorphisms showed an increased risk of stroke. The odds ratios, in univariate and multivariate analysis, for the combined polymorphisms were 4.99 (95% CI, 1.75-14.2, P = 0.001) and 5.29 (95% CI, 1.63-17.1, P = 0.005), respectively.
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Affiliation(s)
- Thierry Paluku They-They
- Department of Clinical Neuroscience and Biological Psychiatry, Hassan II University, BP 9154, 10000, Casablanca, Morocco,
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Abstract
Thrombosis is a major cause of morbidity and mortality worldwide. Genetic factors are one component of thrombosis. We studied the prevalence of two mutations that are known risk factors in the pathogenesis of arterial and venous thrombosis in the genetically isolated Circassian population in Jordan. Factor II G20210A and Factor V Leiden single nucleotide polymorphisms were analysed by polymerase chain reaction and restriction fragment length polymorphism method in 104 random unrelated subjects from the Circassian population in Jordan. The prevalence rates among the Circassian population in Jordan for Factor II G20210A was 12.2% and for Factor V Leiden was 7.7%. We have shown that the population is in Hardy-Weinberg equilibrium and that the prevalences of both mutations are within the range of other ethnic groups. This is the first study to describe Circassian health related genetic characteristics in Jordan. Such population-based studies will contribute to understanding the interaction between genetic and environmental risk factors. It will remain to be seen whether carriers of Factor II G20210A and Factor V Leiden are more likely to develop thrombosis. This issue should be studied in the future to determine the need for screening of these mutations particularly in thrombophilia patients.
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Thornsberry LA, LoSicco KI, English JC. The skin and hypercoagulable states. J Am Acad Dermatol 2013; 69:450-62. [PMID: 23582572 DOI: 10.1016/j.jaad.2013.01.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/19/2013] [Accepted: 01/25/2013] [Indexed: 11/19/2022]
Abstract
Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder. This review will focus on the basic science of hemostasis, the evaluation of HS, the skin manifestations associated with hypercoagulability, and the use of antiplatelet and anticoagulant therapy in dermatology.
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Affiliation(s)
- Laura A Thornsberry
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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14
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Sode BF, Allin KH, Dahl M, Gyntelberg F, Nordestgaard BG. Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type. CMAJ 2013; 185:E229-37. [PMID: 23382263 DOI: 10.1503/cmaj.121636] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population. METHODS We used data from 2 Danish studies that followed members of the general public from 1977 through 2010. We obtained the genotype of 66 001 white participants for ABO blood type, factor V Leiden R506Q and prothrombin G20210A. We calculated hazard ratios (HRs) and population attributable risk. Our main outcome measures were venous thromboembolism and myocardial infarction. RESULTS The multivariable adjusted HR for venous thromboembolism was 1.4 (95% confidence interval [CI] 1.3-1.5) for non-O blood type (v. O blood type). For the factor V Leiden R506Q mutation, the adjusted HR was 2.2 (95% CI 2.0-2.5) for heterozygous participants and 7.0 (95%CI 4.8-10) for homozygous participants (v. participants without the mutation). For prothrombin G20210A, the adjusted HR was 1.5 (95%CI 1.2-1.9) for heterozygous participants and 11 (95% CI 2.8-44) for homozygous participants (v. participants without the mutation). When we combined ABO blood type and factor V Leiden R506Q or prothrombin G20210A genotype, there was a stepwise increase in the risk of venous thromboembolism (trend, p<0.001). The population attributable risk of venous thromboembolism was 20% for ABO blood type, 10% for factor V Leiden R506Q and 1% for prothrombin G20210A. Multivariable adjusted HRs for myocardial infarction by genotypes did not differ from 1.0. INTERPRETATION ABO blood type had an additive effect on the risk of venous thromboembolism when combined with factor V Leiden R506Q and prothrombin G20210A mutations; blood type was the most important risk factor for venous thromboembolism in the general population.
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Affiliation(s)
- Birgitte F Sode
- Department of Clinical Biochemistry, Herlev Hospital, and the Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Myocardial infarction marker levels are influenced by prothrombin and tumor necrosis factor-α gene polymorphisms in young patients. Cytokine 2013; 61:218-22. [DOI: 10.1016/j.cyto.2012.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 01/11/2023]
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16
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Favaretto E, Sartori M, Conti E, Legnani C, Palareti G. G1691A factor V and G20210A FII mutations, acute ischemic stroke of unknown cause, and patent foramen ovale. Thromb Res 2012; 130:720-4. [DOI: 10.1016/j.thromres.2012.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/17/2012] [Accepted: 07/17/2012] [Indexed: 12/22/2022]
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17
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Bondarenko EA, Shetova IM, Shamalov NA, Mocan EI, Barbacar NI, Kurochkin GS, Protopop SS, Lysyi L, Slominsky PA, Limborska SA, Skvortsova VI. Analysis of acute ischemic stroke DNA markers in Russian and Moldavian populations. RUSS J GENET+ 2011. [DOI: 10.1134/s1022795411100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Analysis of polymorphisms Leiden Factor V G1691A and prothrombin G20210A as risk factors for acute myocardial infarction. Biogerontology 2011; 12:485-90. [PMID: 21918818 DOI: 10.1007/s10522-011-9358-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/23/2011] [Indexed: 10/17/2022]
Abstract
Thrombotic risk increases in elderly, therefore, the understanding of the genetic predisposition of hypercoagulability could make the difference in the prevention of venous and/or arterial thrombotic events. Laboratory evaluation of hyperfibrinogenemia, increased Factor VII levels, antiphospholipid antibodies presence and hyperhomocysteinemia are considered to have a consistent high predictivity for arterial thrombophilic diseases. Anyway, a large debate exists on the validity of testing Leiden Factor V (FV) G1691A and/or prothrombin (FII) G20210A polymorphisms in patients affected by arterial thrombotic diseases, despite of the several observations described. Here we report data strongly suggesting that at least the FII G20210A polymorphism might be considered an important risk factor for acute myocardial infarction in aged patients (55-80 years old). On the other hand, in spite of a not different genotypic and allelic distribution for the Leiden FV G1691A mutation, the presence of one or both the two polymorphisms is significantly higher among cases than in controls. In conclusion, our data suggest that FII G20210A and/or Leiden FV might be involved as risk factor for arterial disorders in about 5% of old subjects, justifying the opportunity of a genetic screening and an eventual preventive treatment, in particular in old subjects in which other and major risk factors, as hypertension and atherosclerosis, are detected.
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19
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Liu X, Jiang Y, Russell JE. A potential regulatory role for mRNA secondary structures within the prothrombin 3'UTR. Thromb Res 2010; 126:130-6. [PMID: 20553951 DOI: 10.1016/j.thromres.2010.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 03/10/2010] [Accepted: 04/20/2010] [Indexed: 11/20/2022]
Abstract
The distal 3'UTR of prothrombin mRNA exhibits significant sequence heterogeneity reflecting an inexact 3'-cleavage/polyadenylation reaction. This same region encompasses a single-nucleotide polymorphism that enhances the normal post-transcriptional processing of nascent prothrombin transcripts. Both observations indicate the importance of 3'UTR structures to physiologically relevant properties of prothrombin mRNA. Using a HepG2-based model system, we mapped both the primary structures of reporter mRNAs containing the prothrombin 3'UTR, as well as the secondary structures of common, informative 3'UTR processing variants. A chromatographic method was subsequently employed to assess the effects of structural heterogeneities on the binding of candidate trans-acting regulatory factors. We observed that prothrombin 3'UTRs are constitutively polyadenylated at seven or more positions, and can fold into at least two distinct stem-loop conformations. These alternate structures expose/sequester a consensus binding site for hnRNP-I/PTB-1, a trans-acting factor with post-transcriptional regulatory properties. hnRNP-I/PTB-1 exhibits different affinities for the alternate 3'UTR secondary structures in vitro, predicting a corresponding regulatory role in vivo. These analyses demonstrate a critical link between the structure of the prothrombin 3'UTR and its normal function, providing a basis for further investigations into the molecular pathophysiology of naturally occurring polymorphisms within this region.
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Affiliation(s)
- Xingge Liu
- Department of Medicine (Hematology-Oncology), University of Pennsylvania School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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20
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Jin B, Li Y, Ge-Shang QZ, Ni HC, Shi HM, Shen W. Varied association of prothrombin G20210A polymorphism with coronary artery disease susceptibility in different ethnic groups: evidence from 15,041 cases and 21,507 controls. Mol Biol Rep 2010; 38:2371-6. [PMID: 21080082 DOI: 10.1007/s11033-010-0370-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 11/04/2010] [Indexed: 12/19/2022]
Abstract
Published data on the association between prothrombin G20210A polymorphism and coronary artery disease (CAD) risk are inconclusive. To derive a more precise estimation of the relationship, a meta-analysis was performed. A total of 42 case-control studies including 15,041 cases and 21,507 controls were included in this meta-analysis. Overall, significantly elevated CAD risk was associated with prothrombin G20210A polymorphism (OR, 1.22; 95% CI 1.07-1.40; P=0.003) when 39 eligible studies were pooled into the meta-analysis. In the subgroup analysis, borderline statistically increased risk was found for myocardial infarction in 22 case-control studies (OR, 1.27; 95% CI 1.00-1.61; P=0.05). When stratified by ethnicity, significantly elevated risk was found in Europeans (OR, 1.19; 95% CI, 1.02-1.38; P=0.02). However, no statistical differences were found among Americans and Asians. In summary, this meta-analysis indicated that prothrombin G20210A allele is a low-penetrant risk factor for developing CAD in Europeans.
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Affiliation(s)
- Bo Jin
- Department of Cardiology, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China
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21
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Karkouti K, McCluskey SA, Syed S, Pazaratz C, Poonawala H, Crowther MA. The Influence of Perioperative Coagulation Status on Postoperative Blood Loss in Complex Cardiac Surgery. Anesth Analg 2010; 110:1533-40. [DOI: 10.1213/ane.0b013e3181db7991] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Jurcut R, Florian A, Deleanu D, Arsenescu I, Jurcut C, Coriu D, Ginghina C. Atherothrombosis in 2 Vascular Territories in a Young Woman: Importance of Thrombophilia Testing. Clin Appl Thromb Hemost 2010; 17:108-13. [DOI: 10.1177/1076029609357740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The diagnosis and management of complex and multiple inherited thrombophilias is still a challenge for the clinicians involved in this field, clinical events being the result of the interaction between genes, environmental or other acquired factors, and age. Moreover, various clinical manifestations as regards severity or type of event (venous or arterial thrombotic event, obstetrical complications) are cited in these patients. We present the case of a 20-year-old woman, with a 2-month history of third-generation contraceptive use and with recently diagnosed hypercholesterolemia, who presented ischemic events in 2 arterial territories: acute left lower limb ischemia and silent myocardial infarction. Screening tests for thrombophilia, including genetic testing, showed moderate hyperhomocysteinemia and 2 inherited thrombophilic defects. Invasive investigation of the coronary arteries showed the presence of advanced atherosclerotic disease. Management of this complex thrombophilia includes lifetime oral anticoagulation as well as a homocysteine-lowering strategy comprising lifestyle modification and group B (folic acid, B6, B12) vitamin supplementing.
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Affiliation(s)
- Ruxandra Jurcut
- Department of Cardiology, Institute of Emergency for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu,” Bucharest, Romania,
| | - Anca Florian
- Department of Cardiology, Institute of Emergency for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu,” Bucharest, Romania
| | - Dan Deleanu
- Department of Cardiology, Institute of Emergency for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu,” Bucharest, Romania
| | - Ileana Arsenescu
- Department of Cardiology, Institute of Emergency for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu,” Bucharest, Romania
| | - Ciprian Jurcut
- 3rd Internal Medicine Department, “Dr. Carol Davila” Central Clinical Emergency Military Hospital, Bucharest, Romania
| | - Daniel Coriu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Carmen Ginghina
- Department of Cardiology, Institute of Emergency for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu,” Bucharest, Romania
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23
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Sartori M, Favaretto E, Legnani C, Cini M, Conti E, Pili C, Palareti G. G20210A Prothrombin Mutation and Critical Limb Ischaemia in Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2009; 38:113-7. [DOI: 10.1016/j.ejvs.2009.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 02/24/2009] [Indexed: 11/28/2022]
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24
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Affiliation(s)
- Mark Y Chan
- Duke Clinical Research Institute, Durham, NC 27705, USA
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25
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Criado PR, Rivitti EA, Vasconcellos C, Valente NYS, Martins JEC. Manifestações cutâneas das trombofilias. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000600002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O escopo deste artigo é revisar os estados de hipercoagulabilidade sangüínea (trombofilias) mais provavelmente encontrados por dermatologista. Seus sinais cutâneos incluem o livedo reticular, necrose cutânea, ulcerações e isquemia digital, púrpura retiforme, além de úlceras nas pernas. Revisamos seu tratamento adequado, bem como ressaltamos as manifestações cutâneas que impõem pesquisa laboratorial de trombofilias e os exames indicados nessas situações.
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26
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Munshi A, Aliya N, Jyothy A, Kaul S, Alladi S, Shafi G. Prothombin gene G20210A mutation is not a risk factor for ischemic stroke in a South Indian Hyderabadi Population. Thromb Res 2008; 124:245-7. [PMID: 18995885 DOI: 10.1016/j.thromres.2008.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 09/25/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
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27
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Alhenc-Gelas M, Aiach M. Anomalies constitutionnelles de la coagulation prédisposant à la thrombose. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1155-1984(07)46642-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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de Paula Sabino A, Ribeiro DD, Carvalho MDG, Cardoso J, Dusse LMS, Fernandes AP. Factor V Leiden and increased risk for arterial thrombotic disease in young Brazilian patients. Blood Coagul Fibrinolysis 2006; 17:271-5. [PMID: 16651869 DOI: 10.1097/01.mbc.0000224846.35001.64] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The contribution of mutations in the prothrombin (FII G20210A), methylenetetrahydrofolate reductase (C677T) genes and factor V Leiden (FVL) to the pathogenesis of arterial thrombosis remains controversial. In this study, these polymorphisms were investigated by polymerase chain reaction-restriction fragment length polymorphism in a group of 53 patients that presented arterial thrombosis other than myocardial infarction as a first thrombotic event and 275 control subjects living in the state of Minas Gerais, Brazil. Odds ratio (OR) and chi tests were applied for statistical comparisons. Similar frequencies were detected among patients and control subjects for the C677T mutation. The 20210A mutation was present in 3.6% of the control subjects but was not detected among ischemic stroke patients. Significant differences were detected only for factor V Leiden (odds ratio 7.11; 95% confidence interval 1.55-32.73). Our data indicate that, among these genetic factors, factor V Leiden was identified as an important risk factor for arterial thrombosis in this group of patients. In addition, our results indicate regional differences in the incidence of these genetic factors in Brazil, as compared to the incidences reported in other studies.
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Affiliation(s)
- Adriano de Paula Sabino
- School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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29
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Candito M, Chatel M, Candito E, Lapoussiere M, Mengual R, Van Obberghen E, Dunac A. [Thrombophilic factors in divers with undeserved decompression sickness]. PATHOLOGIE-BIOLOGIE 2006; 54:155-8. [PMID: 16574534 DOI: 10.1016/j.patbio.2005.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Accepted: 03/18/2005] [Indexed: 05/08/2023]
Abstract
UNLABELLED In divers with a vascular disease in decompression sickness, who have not committed any technical error, thrombophilic risk factors were sought. Six cases of confirmed divers, without diving technical error, were investigated. Thrombophilic screening included proteins C, S, antithrombin III, and factor VIII assays, and circulating antibodies, Factor V Leiden, and mutation G20210A mutation in Factor II gene research. Total plasma homocysteine (Hcy), an atherosclerosis factor, even when slightly increased, nutitional factors: folate and vitamins B12 and B6, the cofactors of its metabolism, and inversely correlated with Hcy values, were assayed, and subjects were genotyped for mutation C677T in the MTHFR gene. RESULTS In five divers, Hcy values were moderately increased, and in all the six, folate and/or B12 values were decreased. Three of them showed a genotype TT (mutation C677T), two, the genotype CT, and the sixth, an heterozygous Factor V Leiden. In these divers, a predisposition for vascular diseases, was detected, which was partially curable.
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Affiliation(s)
- M Candito
- Inserm U145 et Laboratoire de Biochimie, Hôpital Pasteur, 30, avenue de la Voie-Romaine, 06002 Nice cedex 01, France.
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30
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Mann KG, Brummel-Ziedins K, Orfeo T, Butenas S. Models of blood coagulation. Blood Cells Mol Dis 2006; 36:108-17. [PMID: 16500122 DOI: 10.1016/j.bcmd.2005.12.034] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/19/2005] [Indexed: 11/23/2022]
Abstract
Our research aims to provide quantitatively transparent, biologically realistic descriptions of the processes involved in hemostasis which will permit predictions of the behavior of the coagulation system in normal and pathologic states. We use four models of coagulation: (1) numerical approximations of the tissue factor (Tf) pathway of thrombin generation based upon mechanism and dynamics; (2) Tf activation of the "blood coagulation proteome" from isolated cells and proteins; (3) Tf activated contact pathway inhibited whole blood in vitro; and (4) blood shed from standardized microvascular wounds in vivo. The results from these models are integrated in interactive assessments aimed at achieving convergence of biochemical rigor and biological authenticity. Microvascular injury is the most biologically secure but least accessible to mechanistic study. Numerical models while quantitatively transparent are biologically limited. By the integrated analyses of all four models, we establish observations which require inclusion or discovery of new parameters to achieve mechanistically interpretable biological reality. Discoveries made in this fashion have included thrombin's role in the initiation phase, TFPI/ATIII/APC synergy interactions, rfVIIa in fVII deficiency, the roles of fVIII and fIX in the Tf reaction, and the cleavage of fIX by fXa membrane. Ideally, our results will provide descriptions which predict the behavior of the biological blood coagulation system under normal and pathologic conditions.
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Affiliation(s)
- Kenneth G Mann
- Department of Biochemistry, 208 South Park Drive, Suite 2, University of Vermont, College of Medicine, Colchester, VT 05446, USA.
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31
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Taymaz H, Erarslan S, Oner ET, Alkan T, Ağirbaşli M, Kirdar B. Sequence variations within the genes related to hemostatic imbalance and their impact on coronary artery disease in Turkish population. Thromb Res 2006; 119:55-62. [PMID: 16472842 DOI: 10.1016/j.thromres.2005.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 12/28/2005] [Accepted: 12/29/2005] [Indexed: 11/15/2022]
Abstract
Coronary artery disease (CAD) is reported to be associated with some genetic risk factors. Since identification of genetic risk factors for CAD in different ethnic groups is important for the development of new intervention and prevention programs, we investigated the association between the R353Q and -323ins10 polymorphisms in Factor VII gene, C677T mutation in MTHFR, Factor V Leiden and PT G20210A mutations and CAD in Turkish population. The promoter region of the PAI-1 gene was also screened by SSCA (single-stranded conformation analysis) using specifically designed primers. 137 CAD patients with early onset documented by coronary angiography and 41 individuals who had no significant coronary stenosis by angiography as control group were screened for the identification of the polymorphisms. In conclusion, Factor V Leiden was found to be an independent genetic risk factor for CAD in Turkish population. Combined risk assessment indicated that the coexistence of two other inherited thrombophilia markers, namely MTHFR C677T and PT G20210A with Factor V Leiden may increase the risk of the development of the disease in this population. The results of the present study show that there is no statistically significant association between the two polymorphisms in Factor VII gene, MTHFR C677T polymorphism, PT G20210A polymorphism, 4G/5G polymorphism of PAI-1 and CAD in Turkish population.
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Affiliation(s)
- Hilal Taymaz
- Department of Chemical Engineering, Bogazici University, 34342 Bebek-Istanbul, Turkey
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32
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Federici C, Gianetti J, Andreassi MG. Genomic medicine and thrombotic risk: Who, when, how and why? Int J Cardiol 2006; 106:3-9. [PMID: 16102857 DOI: 10.1016/j.ijcard.2004.11.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Revised: 11/04/2004] [Accepted: 11/21/2004] [Indexed: 11/27/2022]
Abstract
Major advances in Human Genome research could significantly change the clinical medical practice, providing new possibilities for both diagnosing and treating common pathologies. Many genetic tests are now commercially available for predicting future risk of common disorders. However, genetic testing has potential benefits but also limitations for the patients, and it should not be used to 'screen' the general population. Diagnostic assays for a predisposition of both venous and arterial thrombosis are among the most requested genetic tests in molecular diagnostics laboratories. However, there is considerable uncertainty as to how this information should be utilized in patient management. Both the medical community and the patients need to obtain accurate information concerning the appropriate use of genetic testing. The purpose of this article is to discuss the usefulness and the practical applications of thrombotic genetic testing in order to define which patients should be tested for both venous and arterial thrombotic risk as well as to have an acceptable cost/benefit ratio and to prevent patients' anxiety.
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Affiliation(s)
- Chiara Federici
- Laboratory of Cellular Biology and Genetics, CNR Institute of Clinical Physiology, G. Pasquinucci Hospital, Massa, Italy
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33
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Stern C, Chamley L. Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage. Reprod Biomed Online 2006; 13:29-37. [PMID: 16820106 DOI: 10.1016/s1472-6483(10)62013-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evaluation of patients with IVF implantation failure or recurrent miscarriage often frustratingly fails to elicit any particular cause for their problem. Testing for antiphospholipid antibodies or thrombophilia is commonly carried out, and interpretation of results in the light of the current evidence is extremely difficult. This paper reviews the purported pathogenetic mechanisms and clinical associations between both antiphospholipid antibodies and inherited thrombophilias, and reproductive failure. The current management strategies are also critically evaluated and recommendations are made for optimal, evidence-based clinical practice.
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Affiliation(s)
- Catharyn Stern
- Royal Women's Hospital and Melbourne IVF, Melbourne, Australia.
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34
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Brummel-Ziedins K, Vossen C, Butenas S, Mann K, Rosendaal F. Thrombin generation profiles in deep venous thrombosis. J Thromb Haemost 2005; 3:2497-505. [PMID: 16241948 PMCID: PMC1410192 DOI: 10.1111/j.1538-7836.2005.01584.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reliable markers and methods to predict risk for thrombosis are essential to clinical management. OBJECTIVE Using an integrated approach that defines an individual's comprehensive coagulation phenotype might prove valuable in identifying individuals at risk for experiencing a thrombotic event. METHODS Using a numerical simulation model, we generated tissue factor (TF) initiated thrombin curves using coagulation factor levels from the Leiden Thrombophilia Study population and evaluated thrombotic risk, by sex, age, smoking, alcohol consumption, body mass index (BMI) and oral contraceptive (OC) use. We quantitated the initiation, propagation and termination phases of each individuals' comprehensive TF-initiated thrombin generation curve by the parameters: time to 10 nm of thrombin, maximum time, level and rate (MaxR) of thrombin generated and total thrombin. RESULTS The greatest risk association was obtained using MaxR; with a 2.6-fold increased risk at MaxR exceeding the 90th percentile. The odds ratio (OR) for MaxR was 3.9 in men, 2.1 in women, and 2.9 in women on OCs. The association of risk with thrombin generation did not differ by age (OR:2.8 OR:2.5), BMI (OR:2.9 OR:2.3) or alcohol use. In both numerical simulations and empirical synthetic plasma, OC use created extreme shifts in thrombin generation in both control women and women with a prior thrombosis, with a larger shift in thrombin generation in control women. This suggests an interaction of OC use with underlying prothrombotic abnormalities. CONCLUSIONS Thrombin generation based upon the individual's blood composition is associated with the risk for thrombosis and may be useful as a predictive marker for evaluating thrombosis on an individual basis.
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Affiliation(s)
- K.E. Brummel-Ziedins
- From the Department of Biochemistry, University of Vermont, College of Medicine, Burlington, Vermont and from the
| | - C.Y. Vossen
- Department of Clinical Epidemiology and the Hemostasis and Thrombosis Research Center, Leiden University Medical Center, Leiden, Netherlands
| | - Saulius Butenas
- From the Department of Biochemistry, University of Vermont, College of Medicine, Burlington, Vermont and from the
| | - K.G. Mann
- From the Department of Biochemistry, University of Vermont, College of Medicine, Burlington, Vermont and from the
| | - F.R. Rosendaal
- From the Department of Biochemistry, University of Vermont, College of Medicine, Burlington, Vermont and from the
- Department of Clinical Epidemiology and the Hemostasis and Thrombosis Research Center, Leiden University Medical Center, Leiden, Netherlands
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BRUMMEL-ZIEDINS K, VOSSEN CY, ROSENDAAL FR, UMEZAKI K, MANN KG. The plasma hemostatic proteome: thrombin generation in healthy individuals. J Thromb Haemost 2005; 3:1472-81. [PMID: 15978105 PMCID: PMC1414093 DOI: 10.1111/j.1538-7836.2005.01249.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The range of plasma concentrations of hemostatic analytes in the population is wide. In this study these components of blood coagulation phenotype are integrated in an attempt to predict clinical risk. METHODS We modeled tissue factor (TF)-induced thrombin generation in the control population (N = 473) from the Leiden Thrombophilia Study utilizing a numerical simulation model. Hypothetical thrombin generation curves were established by modeling pro- and anticoagulant factor levels for each individual. These curves were evaluated using parameters which describe the initiation, propagation and termination phases of thrombin generation, i.e. time to 10 nm thrombin (approximate clot time), total thrombin and the maximum rates and levels of thrombin generated. RESULTS AND CONCLUSIONS The time to 10 nm thrombin varied over a 3-fold range (2.9-9.5 min), maximum levels varied over a approximately 4-fold range (200-800 nm), maximum rates varied approximately 4.8-fold (90-435 nm min(-1)) and total thrombin varied approximately 4.5-fold (39-177 microm s(-1)) within this control population. Thrombin generation curves, defined by the clotting factor concentrations, were distinguished by sex, age, alcohol consumption, body mass index (BMI) and oral contraceptive (OC) use (OC > sex > BMI > age). Our results show that the capacity for thrombin generation in response to a TF challenge may represent a method to identify an individual's propensity for developing thrombosis.
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Affiliation(s)
- K. BRUMMEL-ZIEDINS
- Department of Biochemistry, University of Vermont, College of Medicine, Burlington, VT, USA; and
| | - C. Y. VOSSEN
- Department of Clinical Epidemiology and Hemostasis and Thrombosis Research Center, Leiden University Medical Center, Leiden, the Netherlands
| | - F. R. ROSENDAAL
- Department of Clinical Epidemiology and Hemostasis and Thrombosis Research Center, Leiden University Medical Center, Leiden, the Netherlands
| | - K. UMEZAKI
- Department of Biochemistry, University of Vermont, College of Medicine, Burlington, VT, USA; and
| | - K. G. MANN
- Department of Biochemistry, University of Vermont, College of Medicine, Burlington, VT, USA; and
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Gurgey A, Unal S, Okur H, Duru F, Gumruk F. Prothrombin G20210A mutation in Turkish children with thrombosis and the frequency of prothrombin C20209T. Pediatr Hematol Oncol 2005; 22:309-14. [PMID: 16020118 DOI: 10.1080/08880010590935202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prothrombin G20210A mutation has been described as the second most common genetic risk factor in thrombotic patients. Recently a new prothrombin gene variant namely prothrombin C20209T has also been found to be associated with thrombosis. In the present study the frequency of these two thrombin variants have been searched in two different groups. Group 1: A total of 377 children with thrombosis were analyzed during 7 years between January 1997 and 2004 and screened for prothrombin G20210A mutation. Twenty-four of 387 children (6.3%) with thrombosis were diagnosed as having PT G20210A mutation. The mean age of the patients was 6.1 years (median: 6 years, range: 4 months to 17 years, 15 male, 9 female). Six of 24 children were below 2 years of age (25%). Fifteen of 24 children (62.5%) had arterial thrombosis, most of whom (93.3%) had cerebral infarct. Group 2: The prothrombin C20209T variant has been analyzed in 200 thrombotic patients and in 200 healthy subjects. None of the thrombotic patients and healthy individuals carried the prothrombin C20209T variant. In conclusion, arterial thrombosis as the cerebral infarct is the most prominent type of thrombosis in children with prothrombin G20210A mutation. It seems that the prothrombin C20209T variant is not an important risk factor for the population studied.
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Affiliation(s)
- Aytemiz Gurgey
- Department of Pediatrics, Pediatric Hematology Section, Hacettepe University, Faculty of Medicine, Ankara 06100, Turkey.
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37
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Marcucci R, Sofi F, Fedi S, Lari B, Sestini I, Cellai AP, Pulli R, Pratesi G, Pratesi C, Gensini GF, Abbate R. Thrombophilic risk factors in patients with severe carotid atherosclerosis. J Thromb Haemost 2005; 3:502-7. [PMID: 15748240 DOI: 10.1111/j.1538-7836.2005.01173.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Carotid stenosis and atrial fibrillation are the strongest risk factors for ischemic stroke. Ongoing prevention efforts include the identification of novel factors that increase the risk for carotid atherosclerosis. The aim of this study was to determine the thrombophilic risk profile of patients with severe carotid stenosis by evaluating a number of genetic and metabolic risk factors [factor (F)II G20210A, factor V Leiden, MTHFR C677T polymorphisms, anticardiolipin antibodies (aCL), lipoprotein(a) (Lp(a)), and homocysteine (Hcy)]. The study population consisted of 615 patients [(410 M/205 F; median age 73 (26-94) years] with severe (> 70%) carotid stenosis, and 615 apparently healthy subjects [(410 M/205 F; age 73 (31-92) years]. On multivariate analysis, independent risk factors were elevated Hcy [odds ratio (OR) 7.6, 95% confidence interval (CI) 4.8, 11.8] and Lp(a) levels (OR 2.9, 95% CI 2.1, 3.9), the presence of aCL (OR 5.7, 95% CI 3.1, 10.4) and heterozygosity for FII G20210A polymorphism (OR 2.8, 95% CI 1.3, 5.9). In the subgroup of women, independent risk factors for severe carotid atherosclerosis were: high levels of Hcy and Lp(a) and the presence of aCL, whereas hyperhomocysteinemia, elevated Lp(a) levels, aCL, FII G20210A and MTHFR 677TT polymorphisms remained independent risk factors in the subgroup of men. The results of the present study demonstrate that the prevalence of the thrombophilic risk factors is increased in patients with severe carotid atherosclerosis.
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Affiliation(s)
- R Marcucci
- Thrombosis Center, University of Florence, Dipartimento del Cuore e dei Vasi, Center for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies, Firenze, Italy.
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38
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Reny JL, Alhenc-Gelas M, Fontana P, Bissery A, Julia PL, Fiessinger JN, Aiach M, Emmerich J. The factor II G20210A gene polymorphism, but not factor V Arg506Gln, is associated with peripheral arterial disease: results of a case-control study. J Thromb Haemost 2004; 2:1334-40. [PMID: 15304039 DOI: 10.1111/j.1538-7836.2004.00809.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The FIIG20210A polymorphism has been associated with arterial wall thickness and atherothrombotic diseases in selected subgroups. The FVArg506Gln polymorphism does not seem to be associated with arterial diseases. Few data are available on these polymorphisms and the risk of peripheral arterial disease (PAD). OBJECTIVES To study the association between the FIIG20210A and FVArg506Gln polymorphisms and PAD and its clinical severity. To examine the potential interactions with traditional vascular risk factors. PATIENTS AND METHODS We studied 184 consecutive male patients under 70 years of age with symptomatic PAD and 330 age-matched male controls free of symptomatic PAD and with no cardiovascular history. We evaluated the FIIG20210A and FVArg506Gln polymorphisms in all subjects. RESULTS Mean age was 57.1 +/- 7.2 years (cases) and 56.7 +/- 7.6 years (controls). The FII20210A allele was more frequent in PAD patients with odds ratios (OR) of 3.77 (1.39-10.2) in univariate analysis and 4.30 (1.3-14.7) after adjustment for diabetes, smoking, hypertension and hypercholesterolemia. In smokers or past smokers the magnitude of the association was markedly increased but there was no evidence of an interaction between tobacco exposure and FIIG20210A. In case subjects, the FII20210A allele was also associated with critical ischemia [OR = 4.1 (1.1-15.7), P = 0.039 in multivariate analysis]. FVArg506Gln was not associated with PAD [OR = 0.65 (0.27-1.54) and 0.77 (0.28-2.1) in univariate and multivariate analyses, respectively]. CONCLUSIONS The FIIG20210A gene polymorphism may be a risk factor for PAD and its severity. In contrast, the FVArg506Gln polymorphism is not associated with PAD.
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Affiliation(s)
- J L Reny
- Service Médecine Vasculaire, Hôpital Européen Georges Pompidou, Paris, France
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Valdez LL, Quintero A, Garcia E, Olivares N, Celis A, Rivas F, Rivas F. Thrombophilic polymorphisms in preterm delivery. Blood Cells Mol Dis 2004; 33:51-6. [PMID: 15223011 DOI: 10.1016/j.bcmd.2004.04.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 04/30/2004] [Indexed: 10/26/2022]
Abstract
Single nucleotide polymorphisms tumor necrosis factor (TNF) G-308A, coagulation factors V G1691A and II G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, as well as the angiotensin-converting enzyme (ACE) insertion/deletion polymorphism were investigated in 86 women with a history of premature delivery (PD) and compared with those of a control group of adults from Guadalajara, Mexico (a minimum of 162 individuals were typed for each polymorphism). Significant differences in the frequency of these polymorphisms were found for MTHFR C677T (increased), and the ACE deletion (increased) among women who had a history of preterm delivery compared with controls. These polymorphisms therefore might be associated with PD.
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Affiliation(s)
- Laura L Valdez
- Centro de Investigacion Biomedica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
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40
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Abstract
PURPOSE OF REVIEW An update on recent developments in diagnosis and treatment of disseminated intravascular coagulation. RECENT FINDINGS Disseminated intravascular coagulation is defined as a typical disease condition with laboratory findings indicating massive coagulation activation and reduction in procoagulant capacity. Clinical syndromes associated with the condition are consumption coagulopathy, sepsis-induced purpura fulminans, and viral hemorrhagic fevers. Consumption coagulopathy is observed in patients with sepsis, aortic aneurysms, acute promyelocytic leukemia, and other disseminated malignancies. Sepsis-induced purpura fulminans is characterized by microvascular occlusion causing hemorrhagic necrosis of the skin and organ failure. Viral hemorrhagic fevers result in massively increased tissue factor production in monocytes and macrophages, inducing microvascular thrombosis and consumption of platelets and coagulation factors. Current scoring systems do not distinguish between patients with asymptomatic disseminated intravascular coagulation, consumption coagulopathy and thrombotic syndromes. Patients with sepsis may be identified by activated partial thromboplastin time waveform analysis performed as part of routine coagulation testing. Drotrecogin alpha (activated) reduces mortality in patients with severe sepsis with and without disseminated intravascular coagulation and has been used in patients with sepsis-induced purpura fulminans. Tifacogin does not reduce mortality in severe sepsis associated with impaired coagulation. Patients with heterozygous factor V Leiden mutation and severe sepsis showed a lower 28-day mortality than patients without this mutation, supporting the assumption that an enhanced level of coagulation activation may be beneficial in patients with severe sepsis. SUMMARY Whereas antithrombin and tifacogin failed to improve clinical outcome in severe sepsis, drotrecogin alpha (activated) increased the chances of survival of patients with severe sepsis with and without disseminated intravascular coagulation.
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Affiliation(s)
- Carl-Erik Dempfle
- Department of Medicine, University Hospital of Mannheim, Mannheim, Germany.
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41
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Burzotta F, Paciaroni K, De Stefano V, Crea F, Maseri A, Leone G, Andreotti F. G20210A prothrombin gene polymorphism and coronary ischaemic syndromes: a phenotype-specific meta-analysis of 12 034 subjects. BRITISH HEART JOURNAL 2004; 90:82-6. [PMID: 14676252 PMCID: PMC1768005 DOI: 10.1136/heart.90.1.82] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the possible link between the G20210A prothrombin gene variant and different forms of ischaemic heart disease. DESIGN Phenotype-specific meta-analysis of 19 studies published within March 2002, globally including 4944 patients and 7090 controls. Sample size, inclusion criteria, geographical location, clinical presentation, age, cardiovascular risk factors, and angiographic extent of disease were extracted from each study. Analyses were done according to Mantel-Haenszel. RESULTS Overall, the odds ratio (OR) for unspecified ischaemic heart disease associated with the 20210A allele was 1.21 (95% confidence interval (CI) 0.99 to 1.59, n = 12 034). Similar findings were seen for acute coronary syndromes (unstable angina and myocardial infarction) and for myocardial infarction without age limits (OR 1.24, 95% CI 0.98 to 1.63, n = 10 240; and OR 1.19, 95% CI 0.93 to 1.58, n = 9765). The effects were similar in male and female subjects. In the 1931 subjects < 55 years of age, the OR for myocardial infarction increased to 1.77 (95% CI 1.16 to 3.42) and in the 1359 subjects < 45 years to 2.30 (95% CI 1.27 to 4.59). No significant association was found between the 20210A allele and the presence of angiographically documented coronary disease (OR 1.08, 95% CI 0.70 to 1.64, n = 3444). However, patients with 0/1 vessel disease at angiography showed a greater prevalence of the A allele than those with multivessel disease (relative risk 2.0, 95% CI 1.2 to 3.1, n = 2376). CONCLUSIONS G20210A prothrombin gene polymorphism may represent a modest but significant risk factor for myocardial infarction at young ages and favour the expression of ischaemic heart disease among individuals who have a limited extent of coronary atherosclerosis at angiography.
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Affiliation(s)
- F Burzotta
- Institute of Cardiology, Catholic University, Rome, Italy.
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42
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Kim RJ, Becker RC. Association between factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations and events of the arterial circulatory system: a meta-analysis of published studies. Am Heart J 2003; 146:948-57. [PMID: 14660985 DOI: 10.1016/s0002-8703(03)00519-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The association between the inherited gene mutations of factor V, prothrombin, and homocysteine metabolism and venous thromboembolic events is accepted widely; however, their influence on the arterial circulatory system remains controversial. METHODS We performed a MEDLINE search to identify published case-control and cohort studies correlating the factor V Leiden, prothrombin (PT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T (TT genotype) mutations with myocardial infarction, ischemic stroke, or peripheral vascular disease. Studies were included only when they adhered to specific diagnostic criteria for ischemic events and met the published methodological criteria. Odds ratios (ORs) with accompanying 95% CIs were calculated for each mutation and clinical end points with a random-effects model (DerSimonian and Laird method). RESULTS The association between inherited gene mutations and arterial ischemic events was modest: factor V Leiden mutation (OR, 1.21; 95% CI, 0.99-1.49), PT G20210A mutation (OR, 1.32; 95% CI, 1.03-1.69), and MTHFR TT mutation (OR, 1.20; 95% CI, 1.02-1.41). Subgroup analyses of younger patients (<55 years old) and of women revealed slightly stronger associations overall. CONCLUSIONS Genetic abnormalities specific to factor V, prothrombin,and homocysteine metabolism increase the risk for myocardial infarction and ischemic stroke, particularly among younger patients and women. Because the overall association is only modest, screening studies should be limited to carefully selected patient populations. The individual propensity for arterial and venous thrombosis is likely influenced by differing local mechanisms, systemic mechanisms, or both.
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Affiliation(s)
- Robert J Kim
- Department of Internal Medicine, University of Massachusetts-Memorial Medical Center, Worcester, Mass, USA
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Abstract
The authors present a case of sudden death in a previously healthy 36-year-old male. At autopsy there were bilateral pulmonary thromboemboli and right ventricular dilatation. Histologic findings in the lungs included recanalized, old thrombi and evidence of pulmonary hypertension. Genetic analysis for hereditary risk factors was heterozygous positive for the prothrombin G20210A mutation. Implications of this finding, its history and the diagnostic technique shall be discussed. The authors recommend that all cases of deep venous thromboses and pulmonary thromboemboli lacking known risk factors be evaluated for newly described genetic variations associated with an increased risk for venous thrombosis.
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Affiliation(s)
- Thomas A Andrew
- Office of the Chief Medical Examiner of the State of New Hampshire, Concord, New Hampshire, USA.
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Mas VR, Fisher RA, Maluf DG, Wilkinson DS, Garrett CT, Ferreira-Gonzalez A. Hepatic artery thrombosis after liver transplantation and genetic factors: prothrombin G20210A polymorphism. Transplantation 2003; 76:247-9. [PMID: 12865818 DOI: 10.1097/01.tp.0000072017.19075.2e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hepatic artery thrombosis (HAT) after liver transplantation is associated with a high incidence of graft failure. The incidence ranges between 2% and 25%, with an overall incidence of approximately 7%. Different risk factors have been associated, but the participation of genetic factors in the cause of HAT is less well studied. A single-base change (G to A) at position 20210 in the 3' untranslated region of the prothrombin gene is associated with increased plasma levels of prothrombin and might therefore increase the risk for thrombosis. We reviewed our HAT experience in 11 years at Medical College of Virginia hospitals of 491 patients undergoing 533 liver transplantations. There were 14 liver grafts with documented HAT (2.62%) in 13 patients. Prothrombin G20210A polymorphism was found in the DNA obtained from 2 of 14 liver allograft tissues (14.2%) but not in the DNA from leukocytes obtained from the peripheral blood of recipients with HAT.
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Affiliation(s)
- Valeria R Mas
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia 23298-0248, USA
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Abstract
Thromboprophylaxis, primary or secondary, should be considered in selected pregnant women with inherited thrombophilias; such women may be divided into high-, medium- and low-risk categories on the basis of the specific thrombophilic defect and any personal or family history of venous thromboembolism (VTE). Women at high risk of VTE should receive treatment doses of low-molecular-weight heparin (LMWH) throughout pregnancy and should remain on anticoagulation for 6 weeks postpartum, or, where appropriate, long-term. Women at moderate risk should be treated with prophylactic fixed-dose LMWH throughout pregnancy and for 6 weeks postpartum. Women at low risk should receive prophylactic fixed-dose LMWH for 6 weeks postpartum, and low-dose aspirin LDA should be considered during pregnancy. LWMH offers important advantages over unfractionated heparin (UFH); heparin-induced thrombocytopaenia (HIT) and osteopaenia are rarely seen. For treatment doses of LMWH, dosage adjustment based on anti-Xa levels is usually required as pregnancy progresses. Warfarin should be avoided throughout pregnancy. LMWH, UFH and warfarin are safe for breast-feeding mothers.
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Affiliation(s)
- Louise Bowles
- Department of Haematology, University College London Hospitals, WC1E 6DB, London, UK
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Young G, Manco-Johnson M, Gill JC, Dimichele DM, Tarantino MD, Abshire T, Nugent DJ. Clinical manifestations of the prothrombin G20210A mutation in children: a pediatric coagulation consortium study. J Thromb Haemost 2003; 1:958-62. [PMID: 12871361 DOI: 10.1046/j.1538-7836.2003.00116.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prothrombin G20210A mutation is a common risk factor for thrombosis which increases the risk of deep vein thrombosis, stroke, and fetal loss. There are few publications of its clinical manifestations in children. Our objective was to determine the clinical manifestations of the prothrombin mutation in children. Via survey of pediatric hematologists, we collected data on children with thrombosis and the prothrombin mutation. Thirty-eight patients with a thrombotic event were identified as having the prothrombin mutation. Children with arterial thrombosis were younger, less than half had additional risk factors present at the time of the event, and had a high frequency of central nervous system thrombosis. Children with venous thrombosis were older, almost always had additional risk factors present, and had thrombosis occur most often in the extremities, although there were also a significant number of events in the central venous and cerebral circulation. There was a striking predilection for central nervous system events as 30% of all the events and 67% of the arterial events occurred there. In all, 14/38 children (37%) had central nervous system thrombosis. Unlike factor V Leiden and deficiencies of proteins C and S which cause venous thromboembolism, the prothrombin mutation in children is often associated with arterial thrombosis and with central nervous system events. In children with the prothrombin mutation and venous thrombosis, other risk factors are usually present. Therefore, children with arterial or venous thrombosis of any location should be evaluated for the presence of the prothrombin mutation.
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Affiliation(s)
- G Young
- Children's Hospital of Orange County, Orange, California 92868, USA.
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47
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Butt C, Zheng H, Randell E, Robb D, Parfrey P, Xie YG. Combined carrier status of prothrombin 20210A and factor XIII-A Leu34 alleles as a strong risk factor for myocardial infarction: evidence of a gene-gene interaction. Blood 2003; 101:3037-41. [PMID: 12480694 DOI: 10.1182/blood-2002-09-2888] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Studies associating the prothrombin 20210G>A (FII 20210A), factor V Leiden (FVL), and factor XIII Leu34 (FXIII-A Leu34) alleles with myocardial infarction (MI) have yielded conflicting results. Complicated gene-gene interactions, small sample sizes, and heterogeneous genetic and environmental backgrounds may contribute to opposing findings. Simultaneous analysis of multiple gene variants in a large sample size from a genetically isolated population may overcome these weaknesses. Genotyping was performed in 500 MI patients and 500 control subjects from the genetically isolated Newfoundland population to determine the prevalence of the FII 20210A, FVL, and FXIII-A Leu34 variants and their association with MI. Gene-gene interactions were also analyzed. The prevalence of the FII 20210A allele was higher in MI patients (3.2%) than in control subjects (1.0%; P =.015). The FII 20210A allele was also 5.6-fold higher in MI patients younger than 51 years than in age-matched control subjects (P =.04). FVL showed 3.9-fold higher prevalence in young patients than in patients older than 50 years (P =.004) and 2.7-fold higher than in age-matched control subjects (P =.007). Furthermore, the prevalence of combined carriers of the FXIII-A L34 and FII 20210A alleles was 12-fold higher in MI patients than in control subjects (P =.002) and with 92% penetrance. There was disequilibrium of the FXIII-A Leu34 allele to MI patients carrying the FII 20210A allele as a genetic background. Based on our data, we determined that (1) the FII 20210A allele is a risk factor for MI, possibly important for early onset; (2) FVL may predispose for early-onset MI; (3) the FXIII-A Leu34 allele predisposes for MI in males only; however, (4) interaction between the FII 20210A and FXIII-A Leu34 alleles forms a synergistic coeffect that strongly predisposes for MI, placing combined carriers at high risk for MI.
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Affiliation(s)
- Christopher Butt
- Discipline of Laboratory Medicine, Memorial University of Newfoundland, St John's, NF, Canada
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48
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Endler G, Mannhalter C. Polymorphisms in coagulation factor genes and their impact on arterial and venous thrombosis. Clin Chim Acta 2003; 330:31-55. [PMID: 12636925 DOI: 10.1016/s0009-8981(03)00022-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arterial and venous thromboses, with their clinical manifestations such as stroke, myocardial infarction (MI), or pulmonary embolism, are the major causes of death in developed countries. Several studies in twins and siblings have shown that genetic factors contribute significantly to the development of these diseases. Since the advent of molecular genetics in medicine, it has been a focus of interest to elucidate the role of mutations in various candidate genes and their impact on hemostatic disorders such as arterial and venous thromboses. In this article, we review the current knowledge of the contribution of polymorphisms in coagulation factors to the development of thrombotic diseases. We show that in arterial thrombosis, results are controversial. Only for factor XIII 34Leu a protective effect on the development of myocardial infarction has been demonstrated in several studies. No other single polymorphism in a coagulation factor could be confirmed as a relevant risk factor, although there is evidence for a role of factor V Arg506Gln, factor VII Arg353Gln, and vWF Thr789Ala polymorphisms in patient subgroups. Further studies will be necessary to confirm the value of testing for genetic polymorphisms in arterial thrombosis. A large body of data is available on the role of factor V Arg506Gln and the prothrombin G20210A mutation in venous thrombosis. Some papers already recommend diagnosis and treatment strategies. We will discuss these recent publications on venous thrombosis in our review.
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Affiliation(s)
- Georg Endler
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Molecular Biology Division, University Vienna Medical School, Austria
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49
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Abstract
The studies on the combined oral contraceptive (COC) pill and myocardial infarction are reviewed. A reasonable conclusion is that the COC pill causes a two-fold increase in the risk of myocardial infarction. There is a marked interaction with smoking. The pill causes coagulation changes and affects lipoprotein and carbohydrate metabolism and these changes provide a plausible explanation for its effect. However, there are dangers in using these surrogate end-points to predict which pills carry the greatest risk. This must depend on an assessment of the epidemiology, and at present third generation pills have not convincingly been shown to be safer in this regard. The risk of causing myocardial infarction in non-smokers is small but we should be wary of prescribing the pill to smokers over 34 years old and especially to smokers over 39 years old.
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Affiliation(s)
- David Keeling
- Oxford Haemophilia Centre and Thrombosis Unit, Churchill Hospital, Oxford, UK.
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50
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McGlennen RC, Key NS. Clinical and laboratory management of the prothrombin G20210A mutation. Arch Pathol Lab Med 2002; 126:1319-25. [PMID: 12421139 DOI: 10.5858/2002-126-1319-calmot] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To make recommendations regarding the appropriate evaluation for the prothrombin G20210A mutation, as reflected by published evidence and the consensus opinion of recognized experts in the field. DAT SOURCES: Review of the medical literature, primarily since 1996. DATA EXTRACTION AND SYNTHESIS After an initial assessment of the literature, key points defining the condition, and review of the clinical study design, a draft manuscript was prepared and circulated to every participant in the College of American Pathologists Conference on Diagnostic Issues in Thrombophilia before the meeting. Each of the key points and associated recommendations were then presented for discussion at the conference. Recommendations were accepted if a consensus of 70% of experts attending the conference was reached. The results of the discussion were used to revise the manuscript into its final form. CONCLUSIONS Consensus was reached on several recommendations concerning the criteria for testing for the prothrombin G20210A mutation and for the method of testing. First, a major point of consensus was that the prothrombin G20210A mutation is a significant risk factor for venous thromboembolism (VTE) and that testing should be considered in the initial evaluation of suspected inherited thrombophilia. Second, although several analytic methods are commonly used for genetic testing for the prothrombin mutation, all are generally robust and reliable. The recommendations for testing for the prothrombin mutation parallel those for the factor V Leiden mutation and include patients with a history of recurrent VTE, a first episode of VTE before the age of 50 years, a history of an unprovoked VTE at any age, thromboses in unusual anatomic sites, or an affected first-degree relative with VTE. A history of VTE related to pregnancy or estrogen use and unexplained pregnancy loss during the second or third trimesters were also considered to be indications for testing. Other scenarios remain controversial or not recommended, including general population screening.
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Affiliation(s)
- Ronald C McGlennen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, USA.
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