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Comparison between thrombophilic gene polymorphisms among high risk patients. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2020; 58:20-26. [DOI: 10.2478/rjim-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. The purpose of this study was to compare the role of the thrombophilic variants among two groups of high risk patients with vascular disorders and recurrent pregnancy loss.
Methods. 200 patients, including 76 with thrombotic accidents and 124 with two or more idiopathic recurrent miscarriage during the first trimester, were tested for the presence of Factor V (F V) Leiden G1691A, Factor II (F II) G20210A, plasminogen activator inhibitor (PAI) 4G/5G, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms using Real time polymerase chain reaction (RT – PCR) in the Laboratory of Medical Genetics, Varna, Bulgaria between June 2016 and May 2019. Frequencies of thrombophilic gene polymorphisms were compared among the two populations and to the expected genotype frequencies.
Results. Individuals with a history of vascular disorders had a significantly higher frequency of F V Leiden variant compared to women with recurrent miscariage. There was no statistical difference between the analyzed patients for the other three thrombophilic polymorphisms. The allelic frequencies and the expected genotype frequencies of the F V, F II and MTHFR polymorphisms were calculated according to Hardy-Weinberg equilibrium. The percentages of the homozygotes for F V and F II were higher than expected in the two groups of patients. For the MTHFR there was no difference.
Conclusion. F V Leiden remains the strongest risk factor for vascular disorders and recurrent pregnancy loss. Screening for this variant should be recommended to patients with thrombotic accidents and women with repeated miscarriage. The role of F II, PAI and MTHFR remains controversial.
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Turrini M, Bourgain C. Genomic susceptibility in practice: The regulatory trajectory of non-rare thrombophilia (NRT) genetic tests in the clinical management of venous thrombo-embolism (VTE). Soc Sci Med 2020; 304:112903. [DOI: 10.1016/j.socscimed.2020.112903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/23/2023]
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Suppiej A, Gentilomo C, Saracco P, Sartori S, Agostini M, Bagna R, Bassi B, Giordano P, Grassi M, Guzzetta A, Lasagni D, Luciani M, Molinari AC, Palmieri A, Putti MC, Ramenghi LA, Rota LL, Sperlì D, Laverda AM, Simioni P. Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis. First report from the Italian Registry of Pediatric Thrombosis (R. I. T. I., Registro Italiano Trombosi Infantili). Thromb Haemost 2015; 113:1270-7. [PMID: 25761414 DOI: 10.1160/th14-05-0431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 01/14/2015] [Indexed: 11/05/2022]
Abstract
Data from large case series of children with cerebral thrombotic events are pivotal to improve prevention, early recognition and treatment of these conditions. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by a multidisciplinary team, aiming for a better understanding of neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. We analysed data relative to the paediatric cerebral thrombotic events of the R. I. T. I. which occurred between January 2007 and June 2012. In the study period, 79 arterial ischaemic stroke (AIS) events (49 in males) and 91 cerebral sinovenous thrombosis (CSVT) events (65 in males) were enrolled in the R. I. T. I. Mean age at onset was 4.5 years in AIS, and 7.1 years in CSVT. Most common modes of presentation were hemiparesis, seizures and speech disturbances in AIS, and headache, seizures and lethargy in CSVT. Most common etiologies were underlying chronic diseases, vasculopathy and cardiopathy in AIS, and underlying chronic diseases and infection in CSVT. Time to diagnosis exceeded 24 hours in 46 % AIS and 59 % CSVT. Overall data from the Italian Registry are in substantial agreement with those from the literature, despite small differences. Among these, a longer time to diagnosis compared to other registries and case series poses the accent to the need of an earlier recognition of paediatric cerebrovascular events in Italy, in order to enable prompt and effective treatment strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paolo Simioni
- Prof. Paolo Simioni, Department of Medicine, University of Padua Medical School, Via Ospedale 105, 35100 Padua, Italy, Tel.: +39 04 9821 2667, Fax: +39 04 9821 2651, E-mail:
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All deep vein thrombosis patients should be routinely screened for thrombophilia. Dis Mon 2010; 56:563-8. [PMID: 20971326 DOI: 10.1016/j.disamonth.2010.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yang S, Xu L, Wu HM. Rapid multiplexed genotyping for hereditary thrombophilia by SELDI-TOF mass spectrometry. ACTA ACUST UNITED AC 2010; 19:54-61. [PMID: 20186013 DOI: 10.1097/pdm.0b013e3181a814bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 50% of patients with venous thromboembolism also present with hereditary predisposition. The most common genetic factors are single nucleotide polymorphisms (SNPs) of factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T. Genotyping these SNPs helps clinicians to correctly diagnose the disease and properly manage patients. In this study, we report a novel method using surface-enhanced laser desorption and ionization time of flight mass spectrometry to rapidly genotype, in a multiplex fashion, 3 SNPs that predispose patients to thrombosis. First, patient DNA samples were subjected to polymerase chain reaction to amplify and extend the DNA products with masses corresponding to specific genotypes. Polymerase chain reaction products were then applied to Q10 anionic protein chips, undergoing on-chip sample enrichment and clean-up. Finally, the genotypes of the SNPs were determined by surface-enhanced laser desorption and ionization time of flight mass spectrometry. This method offers a rapid turnaround time of less than 5 hours from sample collection to result reporting. The analytical accuracy of each SNP genotyping result has been confirmed by DNA sequencing. In addition, the genotype results produced by this method were validated by comparing them with results obtained by the approved method in the clinical reference laboratory. This novel method is fast, accurate, and reproducible, and thus provides an excellent platform to promote personalized medicine in the management of clotting disorders.
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Affiliation(s)
- Shangbin Yang
- Department of Pathology, Center for Personalized Health Care, College of Medicine, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
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Wu HM, Xu L, Sedmak DD, Marsh CB, Wurster MW. Personalized healthcare in clotting disorders. Per Med 2010; 7:65-73. [DOI: 10.2217/pme.09.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In terms of managing thrombotic disorders, genotype-based individualized patient care emerged as early as 1994 when the association of factor V Leiden (G1691A), and later, prothrombin (G20210A), with thrombotic phenotypes were discovered. Since then, genetic tests for specific thrombophilic SNPs have been routinely incorporated into daily practices in both thrombotic risk assessment and clinical decision-making with respect to prophylactic anti-thrombotic therapy. Recently, the area of pharmacogenomics in major anti-thrombotic drugs, such as warfarin and clopidogrel, has been the principal driver for personalized therapy based on one’s own individual characteristics.
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Affiliation(s)
- Haifeng M Wu
- Clinical Coagulation Laboratory, Departments of Pathology and Internal Medicine, Ohio State University College of Medicine, 164 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - LiHui Xu
- Clinical Coagulation Laboratory, Departments of Pathology and Internal Medicine, Ohio State University College of Medicine, 164 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Daniel D Sedmak
- Clinical Coagulation Laboratory, Departments of Pathology and Internal Medicine, Ohio State University College of Medicine, 164 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Clay B Marsh
- Clinical Coagulation Laboratory, Departments of Pathology and Internal Medicine, Ohio State University College of Medicine, 164 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Mark W Wurster
- Clinical Coagulation Laboratory, Departments of Pathology and Internal Medicine, Ohio State University College of Medicine, 164 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
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Marques MA, Silveira PRMD, Ristow AV, Gress M, Vescovi A, Massière B, Cury Filho JM. Pesquisa de marcadores de trombofilia em eventos trombóticos arteriais e venosos: registro de 6 anos de investigação. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
CONTEXTO: Os autores apresentam uma análise epidemiológica sobre a investigação de marcadores de trombofilia em pacientes que apresentaram eventos trombóticos arteriais e/ou venosos acompanhados no Departamento de Angiologia e de Cirurgia Vascular do CENTERVASC no período de janeiro de 2001 a janeiro de 2007. OBJETIVO: Avaliar a prevalência de marcadores de trombofilias congênitas ou adquiridas nos eventos trombóticos venosos e/ou arteriais. MÉTODOS: Entre janeiro de 2001 e janeiro de 2007, 224 pacientes com eventos trombóticos venosos e/ou arteriais foram submetidos a uma rotina de investigação quanto à presença ou não de marcadores de trombofilia, independentemente da idade e história familiar dos pacientes, topografia do evento e presença ou ausência de fatores trombogênicos extrínsecos. RESULTADOS: Foram detectados marcadores de trombofilia em 112 pacientes (50% dos casos). Nestes, observou-se de modo predominante a positividade para anticorpos antifosfolipídios, anticardiolipina e/ou anticoagulante lúpico (39 casos), bem como a presença do fator V de Leiden (43 casos). O sistema venoso foi significativamente o mais acometido, e a ocorrência associada com condições trombogênicas extrínsecas esteve presente em 56 (50%) dos portadores de marcadores de trombofilias. CONCLUSÕES: A presença de marcadores de trombofilia nos pacientes com eventos trombóticos, venosos e/ou arteriais, independentemente da faixa etária ou da existência de fatores extrínsecos associados, foi significativa.
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Affiliation(s)
- Marcos Arêas Marques
- Centro Integrado de Prevenção, Diagnóstico e Tratamento Vascular; Universidade do Grande Rio
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Jackson BR, Holmes K, Phansalkar A, Rodgers GM. Testing for hereditary thrombophilia: a retrospective analysis of testing referred to a national laboratory. BMC Clin Pathol 2008; 8:3. [PMID: 18384680 PMCID: PMC2324095 DOI: 10.1186/1472-6890-8-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 04/02/2008] [Indexed: 11/10/2022] Open
Abstract
Background Predisposition to venous thrombosis may be assessed through testing for defects and/or deficiencies of a number of hereditary factors. There is potential for confusion about which of these tests are appropriate in which settings. At least one set of recommendations has been published to guide such testing, but it is unclear how widely these have been disseminated. Methods We performed a retrospective analysis of laboratory orders and results at a national referral laboratory to gain insight into physicians' ordering practices, specifically comparing them against the ordering practices recommended by a 2002 College of American Pathologists (CAP) consensus conference on thrombophilia testing. Measurements included absolute and relative ordering volumes and positivity rates from approximately 200,000 thrombophilia tests performed from September 2005 through August 2006 at a national reference laboratory. Quality control data were used to estimate the proportion of samples that may have been affected by anticoagulant therapy. A sample of ordering laboratories was surveyed in order to assess potential measurement bias. Results Total antigen assays for protein C, protein S and antithrombin were ordered almost as frequently as functional assays for these analytes. The DNA test for factor V Leiden was ordered much more often than the corresponding functional assay. In addition, relative positivity rates coupled with elevations in prothrombin time (PT) in many of these patients suggest that these tests are often ordered in the setting of oral anticoagulant therapy. Conclusion In this real-world setting, testing for inherited thrombophilia is frequently at odds with the recommendations of the CAP consensus conference. There is a need for wider dissemination of concise thrombophilia testing guidelines.
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Affiliation(s)
- Brian R Jackson
- University of Utah Department of Pathology, Salt Lake City, UT, USA.
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