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Siragusa S, Malato A, Saccullo G, Iorio A, Di Ianni M, Caracciolo C, Coco LL, Raso S, Santoro M, Guarneri FP, Tuttolomondo A, Pinto A, Pepe I, Casuccio A, Abbadessa V, Licata G, Battista Rini G, Mariani G, Di Fede G. Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: the extended DACUS study. Am J Hematol 2011; 86:914-7. [PMID: 21953853 DOI: 10.1002/ajh.22156] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/25/2011] [Accepted: 07/21/2011] [Indexed: 11/07/2022]
Abstract
The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no-RVT and RVT groups, respectively (relative risk = 7.4; 95% confidence interval = 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis.
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Affiliation(s)
- Sergio Siragusa
- Cattedra ed Unità di Ematologia con trapianto, Dipartimento di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy.
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Ho WK, Hankey GJ, Eikelboom JW. Should adult patients be routinely tested for heritable thrombophilia after an episode of venous thromboembolism? Med J Aust 2011; 195:139-42. [DOI: 10.5694/j.1326-5377.2011.tb03241.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 05/27/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Wai Khoon Ho
- Department of Haematology, Austin Health, Melbourne, VIC
| | - Graeme J Hankey
- Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, WA
| | - John W Eikelboom
- Department of Medicine, McMaster University, and Hamilton General Hospital, Hamilton, Ontario, Canada
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Lijfering WM, Middeldorp S, Veeger NJ, Hamulyák K, Prins MH, Büller HR, van der Meer J. Risk of Recurrent Venous Thrombosis in Homozygous Carriers and Double Heterozygous Carriers of Factor V Leiden and Prothrombin G20210A. Circulation 2010; 121:1706-12. [PMID: 20368522 DOI: 10.1161/circulationaha.109.906347] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Homozygous or double heterozygous factor V Leiden and/or prothrombin G20210A is a rare inherited thrombophilic trait. Whether individuals with this genetic background have an increased risk of recurrent venous thrombosis is uncertain.
Methods and Results—
A case-control design within a large cohort of families with thrombophilia was chosen to calculate the risk of recurrent venous thrombosis in individuals with homozygosity or double heterozygosity of factor V Leiden and/or prothrombin G20210A. Cases were individuals with recurrent venous thrombosis, and controls were those with only 1 venous thrombosis. The cohort consisted of 788 individuals with venous thrombosis; 357 had factor V Leiden, 137 had prothrombin G20210A, 27 had factor V Leiden and/or prothrombin G20210A homozygosity, and 49 had double heterozygosity for both mutations. We identified 325 cases with recurrent venous thrombosis and 463 controls with only 1 venous thrombosis. Compared with noncarriers, crude odds ratio for recurrence was 1.2 (95% confidence interval, 0.9 to 1.6) for heterozygous carriers of factor V Leiden, 0.7 (95% confidence interval, 0.4 to 1.2) for prothrombin G20210A, 1.2 (95% confidence interval, 0.5 to 2.6) for homozygous carriers of factor V Leiden and/or prothrombin G20210A, and 1.0 (95% confidence interval, 0.6 to 1.9) for double heterozygotes of both mutations. Adjustments for age, sex, family status, first event type, and concomitance of natural anticoagulant deficiencies did not alter the risk estimates.
Conclusions—
In this study, individuals with homozygous factor V Leiden and/or homozygous prothrombin G20210A or double heterozygous carriers of factor V Leiden and prothrombin G20210A did not have a high risk of recurrent venous thrombosis.
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Affiliation(s)
- Willem M. Lijfering
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Saskia Middeldorp
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Nic J.G.M. Veeger
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Karly Hamulyák
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Martin H. Prins
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Harry R. Büller
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
| | - Jan van der Meer
- From the Division of Hemostasis and Thrombosis, Department of Hematology, University Medical Center Groningen, Groningen (W.M.L., N.J.G.M.V., J.v.d.M.); Department of Vascular Medicine, Academic Medical Center, Amsterdam (S.M., H.R.B.); Departments of Hematology (K.H.) and Clinical Epidemiology and Medical Technology Assessment (M.H.P.), Maastricht University Medical Center, Maastricht; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden (W.M.L., S.M.), the Netherlands
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