|
1
|
Vrotniakaite-Bajerciene K, Tritschler T, Jalowiec KA, Broughton H, Brodard J, Porret NA, Haynes A, Rovo A, Kremer Hovinga JA, Aujesky D, Angelillo-Scherrer A. Thrombophilia Impact on Treatment Decisions, Subsequent Venous or Arterial Thrombosis and Pregnancy-Related Morbidity: A Retrospective Single-Center Cohort Study. J Clin Med 2022; 11:jcm11144188. [PMID: 35887951 PMCID: PMC9316471 DOI: 10.3390/jcm11144188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Thrombophilia testing utility has remained controversial since its clinical introduction, because data on its influence on treatment decisions are limited. (2) Methods: We conducted a single-center retrospective cohort study of 3550 unselected patients referred for thrombophilia consultation at the Bern University Hospital in Switzerland from January 2010 to October 2020. We studied the influence of thrombophilia testing results on treatment decisions and evaluated the association between thrombophilia and thromboembolic and pregnancy-related morbidity events after testing up to 03/2021. (3) Results: In 1192/3550 patients (34%), at least one case of thrombophilia was found and 366 (10%) had high-risk thrombophilia. A total of 211/3550 (6%) work-ups (111/826 (13%) with low-risk thrombophilia and 100/366 (27%) with high-risk thrombophilia) led to an appropriate decision to extend or initiate anticoagulation, and 189 (5%) negative results led to the withholding of anticoagulation therapy inappropriately. A total of 2492 patients (69%) were followed up for >30 days, with a median follow-up of 49 months (range, 1−183 months). Patients with high-risk thrombophilia had a higher risk of subsequent venous thromboembolic events and pregnancy-related morbidity compared to those without thrombophilia. (4) Conclusions: Our study demonstrated the limited usefulness of thrombophilia work-up in clinical decision-making. High-risk thrombophilia was associated with subsequent venous thromboembolism and pregnancy-related morbidity.
Collapse
Affiliation(s)
- Kristina Vrotniakaite-Bajerciene
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
- Correspondence:
| | - Tobias Tritschler
- Department of General Internal Medicine, Bern University Hospital, 3010 Bern, Switzerland; (T.T.); (D.A.)
| | - Katarzyna Aleksandra Jalowiec
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
| | - Helen Broughton
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Justine Brodard
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Naomi Azur Porret
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Alan Haynes
- Clinical Trials Unit Bern, University of Bern, 3012 Bern, Switzerland;
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Johanna Anna Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, 3010 Bern, Switzerland; (T.T.); (D.A.)
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, 3010 Bern, Switzerland; (K.A.J.); (H.B.); (J.B.); (N.A.P.); (A.R.); (J.A.K.H.); (A.A.-S.)
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| |
Collapse
|
|
2
|
Gaddh M, Rosovsky RP. Venous Thromboembolism: Genetics and Thrombophilias. Semin Respir Crit Care Med 2021; 42:271-283. [PMID: 33694139 DOI: 10.1055/s-0041-1723937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Venous thromboembolism (VTE) is a major cause of morbidity and mortality throughout the world. Up to one half of patients who present with VTE will have an underlying thrombophilic defect. This knowledge has led to a widespread practice of testing for such defects in patients who develop VTE. However, identifying a hereditary thrombophilia by itself does not necessarily change outcomes or dictate therapy. Furthermore, family history of VTE by itself can increase an asymptomatic person's VTE risk several-fold, independent of detecting a known inherited thrombophilia. In this article, we will describe the current validated hereditary thrombophilias including their history, prevalence, and association with VTE. With a focus on evaluating both risks and benefits of testing, we will also explore the controversies of why, who, and when to test as well as discuss contemporary societal guidelines. Lastly, we will share how these tests have been integrated into clinical practice and how to best utilize them in the future.
Collapse
Affiliation(s)
- Manila Gaddh
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel P Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|