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Alipanahzadeh H, Ghulamreza R, Shokouhian M, Bagheri M, Maleknia M. Deep vein thrombosis: a less noticed complication in hematologic malignancies and immunologic disorders. J Thromb Thrombolysis 2019; 50:318-329. [PMID: 31808122 DOI: 10.1007/s11239-019-02005-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deep vein thrombosis (DVT) is a common complication in hematologic malignancies and immunologic disorders that coagulation and inflammatory factors play a crucial role in its occurrence. The content used in this article has been obtained by PubMed database and Google Scholar search engine of English-language articles (1980-2019) using the "Deep vein thrombosis," "Hematologic malignancies," "Immunologic disorders" and "Treatment." Increased levels of coagulation factors, the presence of genetic disorders, or the use of thrombotic drugs that stimulate coagulation processes are risk factors for the development of DVT in patients with hematologic malignancies. Inflammatory and auto-anti-inflammatory factors, along with coagulant factors, play an essential role in the formation of venous thrombosis in patients with immunological disorders by increasing the recruitment of inflammatory cells and adhesion molecules. Therefore, anti-coagulants in hematologic malignancies and immunosuppressants in immune disorders can reduce the risk of developing DVT by reducing thrombotic and inflammatory activity. Considering the increased risk of DVT due to impaired coagulation and inflammation processes, analysis of coagulation and inflammatory factors have prognostic values in patients with immunologic deficiencies and hematologic malignancies. Evaluation of these factors as diagnostic and prognostic biomarkers in the prediction of thrombotic events could be beneficial in implementing effective treatment strategies for DVT.
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Affiliation(s)
- Hassan Alipanahzadeh
- Department of Anatomy, Faculty of Medicine, Kabul University Medical Science, Kabul, Afghanistan
| | - Reza Ghulamreza
- Department of Abdominal Surgery, Faculty of Medicine, Kabul University Medical Science, Kabul, Afghanistan
| | - Mohammad Shokouhian
- Department of Hematology and Blood Transfusion, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Marziye Bagheri
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Maleknia
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Momot AP, Nikolaeva MG, Yasafova NN, Zainulina MS, Momot KA, Taranenko IA. Clinical and laboratory manifestations of the prothrombin gene mutation in women of reproductive age. J Blood Med 2019; 10:255-263. [PMID: 31447596 PMCID: PMC6684553 DOI: 10.2147/jbm.s212759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022] Open
Abstract
Research objective To research the association of prothrombin (factor II) activity given the prothrombin G20210A mutation carriage with its clinical manifestations as thrombotic complications. Materials and methods A prospective clinical cohort study of 290 women of reproductive age was conducted. Two cohort groups were identified: the study group of 140 patients with prothrombin mutation G20210A genotype and the control group of 150 women with G20210G genotype. Results The prothrombin G20210A mutation carriage is associated with the risk of thrombotic complications compared to the wild G20210G type (RR =17.1; p<0.0001) and is characterized by thrombosis localized both in the venous (66.7%) and arterial (33.3%) vascular pools. The threshold value of prothrombin activity (174.8%) for G20210A genotype was calculated, making it possible to conclusively predict the risk of thrombotic events with the accuracy of 90.4%. Conclusion The phenotypic manifestation of the prothrombin G20210A mutation in the form of venous and arterial thromboses in women of reproductive age is associated with a super-threshold increase in prothrombin (factor II) activity, which makes it possible to stratify the patients into the group of high risk of thromboses.
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Affiliation(s)
- A P Momot
- Altai Branch of FSBI, National Research Center for Hematology, Barnaul, Russia
| | - M G Nikolaeva
- Obstetrics and Gynecology Department with The Course in Supplementary Vocational Education at FSBI of Higher Education, Altai State Medical University, Barnaul, Russia
| | - N N Yasafova
- Altai Branch of FSBI, National Research Center for Hematology, Ministry of Healthcare of the Russian Federation, Barnaul, Russia
| | - M S Zainulina
- Saint Petersburg State-Financed Health Institution, "Maternity Hospital № 6 Named after Professor V.F. Snegirev", Obstetrics, Gynecology and Reproductive Medicine Department, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - K A Momot
- Altai Branch of FSBI, National Research Center for Hematology, Ministry of Healthcare of the Russian Federation, Barnaul, Russia
| | - I A Taranenko
- Altai Branch of FSBI, National Research Center for Hematology, Ministry of Healthcare of the Russian Federation, Barnaul, Russia
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Pomero F, Borretta V, Gianni M, Squizzato A, Fenoglio L, Ageno W, Prisco D, Dentali F. Location of venous thrombosis in patients with FVL or prothrombin G20210A mutations: Systematic review and meta-analysis. Thromb Haemost 2017; 110:191-4. [DOI: 10.1160/th13-02-0163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/03/2013] [Indexed: 11/05/2022]
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Legnani C, Pengo V, Ghirarduzzi A, Testa S, Poli D, Prisco D, Tripodi A, Palareti G, Cosmi B. The influence of factor V Leiden and G20210A prothrombin mutation on the presence of residual vein obstruction after idiopathic deep-vein thrombosis of the lower limbs. Thromb Haemost 2017; 109:510-6. [DOI: 10.1160/th12-01-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 12/14/2012] [Indexed: 11/05/2022]
Abstract
SummaryIt was our aim to assess whether factor V Leiden (FVL) and G20210A prothrombin (FII) mutation are associated with the presence of residual vein obstruction (RVO) after a standard course of anticoagulation for a first episode of idiopathic proximal deep-vein thrombosis (DVT) of the lower limbs, with or without symptomatic pulmonary embolism (PE). Patients were enrolled in two prospective multicentre studies: PROLONG and PROLONG II. RVO was detected by compression ultra-sonography according to the method of Prandoni on the day of anticoagulation withdrawal. Patients were also screened for FVL and FII mutation. The presence of FVL and/or FII mutation was determined in 872/963 (90.5%) patients, in 753 of whom RVO was assessed. FVL was significantly less frequent among subjects with isolated PE (7/176:4%) than among patients with either DVT and PE (15/133:11.3%; p=0.0018) or isolated DVT (89/563:15.8%; p<0.0001), confirming the FVL paradox. The rate of FII mutation was similar among patients with isolated PE (11/176:6.2%) and patients with either DVT and PE (12/133:9%) or isolated DVT (52/563:9.2%). FVL and FII mutation were not significantly associated with RVO at the multivariate analysis in all patients, although data suggest that FVL and FII mutation may have a differential effect on RVO in the subgroups of patients with DVT and DVT plus PE patients. Male sex and isolated DVT were significantly associated with RVO in all patients. In conclusion, male sex and isolated DVT are associated with RVO, while FVL and FII mutations are not significantly associated with RVO in this study.
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Ensor J, Riley RD, Jowett S, Monahan M, Snell KI, Bayliss S, Moore D, Fitzmaurice D. Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation. Health Technol Assess 2016; 20:i-xxxiii, 1-190. [PMID: 26879848 DOI: 10.3310/hta20120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Unprovoked first venous thromboembolism (VTE) is defined as VTE in the absence of a temporary provoking factor such as surgery, immobility and other temporary factors. Recurrent VTE in unprovoked patients is highly prevalent, but easily preventable with oral anticoagulant (OAC) therapy. The unprovoked population is highly heterogeneous in terms of risk of recurrent VTE. OBJECTIVES The first aim of the project is to review existing prognostic models which stratify individuals by their recurrence risk, therefore potentially allowing tailored treatment strategies. The second aim is to enhance the existing research in this field, by developing and externally validating a new prognostic model for individual risk prediction, using a pooled database containing individual patient data (IPD) from several studies. The final aim is to assess the economic cost-effectiveness of the proposed prognostic model if it is used as a decision rule for resuming OAC therapy, compared with current standard treatment strategies. METHODS Standard systematic review methodology was used to identify relevant prognostic model development, validation and cost-effectiveness studies. Bibliographic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched using terms relating to the clinical area and prognosis. Reviewing was undertaken by two reviewers independently using pre-defined criteria. Included full-text articles were data extracted and quality assessed. Critical appraisal of included full texts was undertaken and comparisons made of model performance. A prognostic model was developed using IPD from the pooled database of seven trials. A novel internal-external cross-validation (IECV) approach was used to develop and validate a prognostic model, with external validation undertaken in each of the trials iteratively. Given good performance in the IECV approach, a final model was developed using all trials data. A Markov patient-level simulation was used to consider the economic cost-effectiveness of using a decision rule (based on the prognostic model) to decide on resumption of OAC therapy (or not). RESULTS Three full-text articles were identified by the systematic review. Critical appraisal identified methodological and applicability issues; in particular, all three existing models did not have external validation. To address this, new prognostic models were sought with external validation. Two potential models were considered: one for use at cessation of therapy (pre D-dimer), and one for use after cessation of therapy (post D-dimer). Model performance measured in the external validation trials showed strong calibration performance for both models. The post D-dimer model performed substantially better in terms of discrimination (c = 0.69), better separating high- and low-risk patients. The economic evaluation identified that a decision rule based on the final post D-dimer model may be cost-effective for patients with predicted risk of recurrence of over 8% annually; this suggests continued therapy for patients with predicted risks ≥ 8% and cessation of therapy otherwise. CONCLUSIONS The post D-dimer model performed strongly and could be useful to predict individuals' risk of recurrence at any time up to 2-3 years, thereby aiding patient counselling and treatment decisions. A decision rule using this model may be cost-effective for informing clinical judgement and patient opinion in treatment decisions. Further research may investigate new predictors to enhance model performance and aim to further externally validate to confirm performance in new, non-trial populations. Finally, it is essential that further research is conducted to develop a model predicting bleeding risk on therapy, to manage the balance between the risks of recurrence and bleeding. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003494. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joie Ensor
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.,Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Richard D Riley
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.,Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Sue Jowett
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Mark Monahan
- Health Economics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Kym Ie Snell
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Susan Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - David Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Venous Thromboembolic Disease in Children and Adolescents. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:149-165. [DOI: 10.1007/5584_2016_113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Karimi A, Abolhasani M, Hashemzadeh-Chaleshtori M, Pourgheysari B. A preliminary study of inherited thrombophilic risk factors in different clinical manifestations of venous thromboembolism in central Iran. Indian J Med Res 2015; 142:46-52. [PMID: 26261166 PMCID: PMC4557250 DOI: 10.4103/0971-5916.162096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background & objectives: Inherited thrombophilia is known to be an important risk factor for developing venous thromboembolism. Whether such abnormalities may impact the development of deep vein thrombosis (DVT) and pulmonary embolism (PE) differently is not well defined. This preliminary study was undertaken to compare thrombophilic polymorphism in patients with DVT and PE. Methods: A total of 35 DVT, 23 DVT/PE, and 37 PE patients admitted to the Hajar Hospital, Shahrekord, Iran, between October 2009 and February 2011 were included in the study and 306 healthy volunteers matched by age and sex from the same geographical area with no history of venous or arterial diseases were included as control group. Factor V Leiden (FV 1691G/A, rs6025), prothrombin (FII 20210G/A), methylene tetrahydrofulate reductase (MTHFR 677C/T, rs1801133), and PLA2 polymorphisms of platelet glycoprotein IIb/IIIa (GpIIIa 1565T/C, rs5918) were investigated by polymerase chain reaction-restriction fragment length polymorphism. Results: The number of patients with the investigated polymorphisms and homozygous carriers was significantly different among the groups (P<0.05). No significant difference was observed in the presence of FV 1691G/A and FII 20210G/A between any of the patients groups and the control group. GpIIIa 1565T/C and homozygous MTHFR 677C/T polymorphisms were higher in DVT patients compared with the control group (OR=6.65, 95% CI=3.09-14.30 and OR=4.08, 95% CI=1.35-12.38, respectively). Interpretation & conclusions: As none of the investigated polymorphisms were associated with PE, other thrombophilia polymorphisms may have a role in the pathogenesis of PE in these patients and should be investigated. Because of different prognostic risk factors among different types of patients, the treatment approach could be different.
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Affiliation(s)
| | | | | | - Batoul Pourgheysari
- Pathology & Hematology Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Krajcoviechova A, Wohlfahrt P, Mayer O, Vanek J, Hajkova J, Hlinovsky D, Kvasnicka T, Tremblay J, Hamet P, Filipovsky J, Kvasnicka J, Cifkova R. Tobacco smoking strongly modifies the association of prothrombin G20210A with undetermined stroke: Consecutive survivors and population-based controls. Atherosclerosis 2015; 240:446-52. [DOI: 10.1016/j.atherosclerosis.2015.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/29/2022]
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9
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Folsom AR, Tang W, Roetker NS, Kshirsagar AV, Derebail VK, Lutsey PL, Naik R, Pankow JS, Grove ML, Basu S, Key NS, Cushman M. Prospective study of sickle cell trait and venous thromboembolism incidence. J Thromb Haemost 2015; 13:2-9. [PMID: 25393788 PMCID: PMC4294976 DOI: 10.1111/jth.12787] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sickle cell trait may increase risk of venous thromboembolism, but this is not fully established. OBJECTIVES We sought to determine the association of sickle cell trait with deep vein thrombosis and pulmonary embolism. METHODS Middle-aged African Americans participating in a prospective, population-based cohort investigation, the Atherosclerosis Risk in Communities Study, were followed from 1987 through 2011 for incident hospitalized pulmonary embolism (n = 111) or isolated deep vein thrombosis (n = 138), verified by physician review of medical records. Sickle cell trait (heterozygosity for hemoglobin S, n = 268) was compared with no sickle cell trait (n = 3748). RESULTS Over a median of 22 years of follow-up, 249 participants had an incident venous thromboembolism. The hazard ratio of venous thromboembolism was 1.50 (95% confidence interval [CI] 0.96-2.36) for participants with vs. without sickle cell trait, after adjustment for age, sex, ancestry, hormone replacement therapy (women), body mass index, diabetes, and estimated glomerular filtration rate. This hazard ratio was 2.05 (95% CI 1.12-3.76) for pulmonary embolism and 1.15 (95% CI 0.58-2.27) for deep vein thrombosis without pulmonary embolism. CONCLUSIONS Sickle cell trait in African Americans carries a 2-fold increased risk of pulmonary embolism but does not elevate deep vein thrombosis risk. Because neonatal screening for sickle hemoglobin is being conducted in the United States, consideration should be paid to the increased pulmonary embolism risk of individuals with sickle cell trait.
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Affiliation(s)
- A R Folsom
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Tófano VAC, Maffei FHA, Rollo HA, Sobreira ML, Padovani CR, Santos ITA. Long-term clinical and ultrasonographic evaluation of thrombophilic patients with deep venous thrombosis. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Dentali F, Ageno W, Bozzato S, Malato A, Gianni M, Squizzato A, Prisco D. Role of factor V Leiden or G20210A prothrombin mutation in patients with symptomatic pulmonary embolism and deep vein thrombosis: a meta-analysis of the literature. J Thromb Haemost 2012; 10:732-7. [PMID: 22329698 DOI: 10.1111/j.1538-7836.2012.04656.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Djordjevic V, Mitic G, Pruner I, Kovac M, Radojkovic D. Are thrombophilia more multifactorial than we thought: report of mosaicism for FII G20210A and novel FII T20061C gene variants. J Thromb Haemost 2012; 10:301-3. [PMID: 22141575 DOI: 10.1111/j.1538-7836.2011.04580.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corral J, Roldán V, Vicente V. Deep venous thrombosis or pulmonary embolism and factor V Leiden: enigma or paradox. Haematologica 2011; 95:863-6. [PMID: 20513806 DOI: 10.3324/haematol.2010.023432] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Blostein MD, Rajotte I, Rao DP, Holcroft CA, Kahn SR. Elevated plasma gas6 levels are associated with venous thromboembolic disease. J Thromb Thrombolysis 2011; 32:272-8. [DOI: 10.1007/s11239-011-0597-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Mitic G, Kovac M, Jurisic D, Djordjevic V, Ilic V, Salatic I, Spasic D, Novakov Mikic A. Clinical characteristics and type of thrombophilia in women with pregnancy-related venous thromboembolic disease. Gynecol Obstet Invest 2011; 72:103-8. [PMID: 21606637 DOI: 10.1159/000323828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 12/14/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal pregnancy is characterized by numerous changes in the hemostatic system, creating the hypercoagulable state which increases the risk of venous thromboembolic event (VTE) occurrence. The risk is further increased by the presence of inherited or acquired thrombophilia. OBJECTIVE In this study, we aimed to determine the prevalence of different types of thrombophilia in women with pregnancy-related VTE, and to investigate the possible connection between the type of thrombophilia and localization of VTE as well as the gestational age of VTE occurrence. PARTICIPANTS AND METHODS Two hundred and two women with the first episode of pregnancy-related VTE and 130 controls were investigated. The antithrombin, protein C and protein S activity, APC resistance, FVG1691A, and FIIG20210A were determined. None of the investigated women was pregnant at the time of thrombophilia testing, and none was using oral contraceptives. RESULTS Thrombophilia was diagnosed in 95 patients (47%) and 7 controls (5.4%). The prevalence of FV Leiden, FIIG20210A mutations, antithrombin, PC and PS deficiencies taken together and combined thrombophilia was 22.3, 10.4, 6.9 and 6.9%, respectively. Significantly more frequent antepartum occurrence of VTE (11 vs. 3, p < 0.05) was found in women with natural coagulation inhibitor deficiency. Pulmonary embolism occurred more frequently in nonthrombophilic women (25 vs. 3, p < 0.001). CONCLUSION Inherited thrombophilia was found to be considerably more frequently present in women with pregnancy- and puerperium-related VTE compared to healthy controls. Women with thrombophilia are at higher risk of developing thromboses localized in the iliacofemoral region, and women without thrombophilia are at higher risk of developing pulmonary embolism. Deficiency in natural coagulation inhibitors is associated with antepartum VTE occurrence.
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Affiliation(s)
- Gorana Mitic
- Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia.
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Gadelha T, Roldán V, Lecumberri R, Trujillo-Santos J, del Campo R, Poggio R, Monreal M. Clinical characteristics of patients with factor V Leiden or prothrombin G20210A and a first episode of venous thromboembolism. Findings from the RIETE Registry. Thromb Res 2010; 126:283-6. [DOI: 10.1016/j.thromres.2010.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 05/12/2010] [Accepted: 06/17/2010] [Indexed: 11/26/2022]
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Severinsen MT, Johnsen SP, Tjønneland A, Overvad K, Dethlefsen C, Kristensen SR. Body height and sex-related differences in incidence of venous thromboembolism: a Danish follow-up study. Eur J Intern Med 2010; 21:268-72. [PMID: 20603033 DOI: 10.1016/j.ejim.2010.03.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/04/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sex-related differences in incidence rate of venous thromboembolism (VTE) have been reported. It is unclear whether these differences reflect sex-related differences in the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) or both and to which extent the differences are mediated by known risk factors for VTE. OBJECTIVE To compare the incidence of DVT and PE between middle-aged men and women. METHODS We computed sex-specific incidences of VTE, DVT and PE and estimated the crude and adjusted incidence rate ratios (IRR) of VTE, DVT and PE using Cox regression for men versus women participating in the prospective study Diet, Cancer and Health. We controlled for body mass index, body height, leisure-time physical activity and smoking dose. RESULTS We verified 641 VTE events during a median follow-up time of 10 years. The overall incidence of VTE was 1.15 [95%CI: 1.07-1.25] per thousand person years; it was higher for men than women (crude IRR: 1.55 [95%CI: 1.32-1.82]). The adjusted IRR for DVT was 1.06 [95%CI: 0.75-1.50] and for PE 0.60 [95%CI: 0.41-1.18] for men versus women. The higher rate among men appeared to be mediated mainly by body height. CONCLUSIONS In this middle-aged population, men experienced a higher incidence of VTE due to a higher incidence of DVT. The higher incidence among men appeared to be mediated by body height. Adjusted for body height, male sex was not associated with an excess risk of either VTE or DVT but the risk of PE was notably lower compared with women.
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Risk factors for clinical manifestations in carriers of Factor V Leiden and prothrombin gene mutations. Blood Coagul Fibrinolysis 2010; 21:11-5. [DOI: 10.1097/mbc.0b013e32832d6ce7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Stralen K, Doggen C, Bezemer I, Pomp E, Lisman T, Rosendaal F. Mechanisms of the Factor V Leiden Paradox. Arterioscler Thromb Vasc Biol 2008; 28:1872-7. [DOI: 10.1161/atvbaha.108.169524] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Carriers of the factor V Leiden mutation (FVL-carriers) have a substantially increased risk of deep venous thrombosis (DVT), whereas the risk of pulmonary embolism (PE) is only mildly increased compared with noncarriers. So far few studies have investigated possible mechanisms for this so-called FVL paradox.
Methods and Results—
Consecutive patients with a first DVT or PE were included in a large population-based case-control study (MEGA study). Patients, aged 18 to 70 years, provided a questionnaire, DNA (n=3313), or plasma (n=1474). Surgery, injury, and travel were considered thrombosis-provocative. Of 2063 patients with isolated DVT, 20% were FVL-carrier, as were 8% of the 885 patients with isolated PE. Among DVT patients, FVL-carriers had their thrombi more often proximal and a higher number of affected veins than noncarriers. No differences were observed between FVL-carriers and noncarriers in time between provocation and diagnosis, in vitro coagulation time, and thrombus density. Compared with patients with both DVT and PE, isolated DVT patients more often had thrombi located distally and had a similar number of affected veins. Compared with isolated PE patients, isolated DVT patients had a similar time between provocation and diagnosis, and similar in vitro coagulation time and thrombus density.
Conclusion—
Although some effects were differential for FVL-carriers and noncarriers, and some were differential for PE and DVT patients, none of the potential mechanisms offered a clear explanation.
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Affiliation(s)
- K.J. van Stralen
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
| | - C.J.M. Doggen
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
| | - I.D. Bezemer
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
| | - E.R. Pomp
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
| | - T. Lisman
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
| | - F.R. Rosendaal
- From the Department of Clinical Epidemiology (K.J.v.S., C.J.M.D., I.D.B., E.R.P., F.R.R.), Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), and the Department of Thrombosis and Hemostasis (F.R.R.), Leiden University Medical Center, the Netherlands; the Department of Clinical Chemistry and Haematology (T.L.), University Medical Centre Utrecht, The Netherlands; and the Surgical Research Laboratory (T.L.), Department of Surgery, University Medical Centre Groningen, University of
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Type and Location of Venous Thromboembolism in Carriers of Factor V Leiden or Prothrombin G20210A Mutation Versus Patients With No Mutation. Clin Appl Thromb Hemost 2008; 16:66-70. [DOI: 10.1177/1076029608320721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Factor V Leiden (FVLeiden) and prothrombin G20210A are the most common genetic causes of thrombophilia and established risk factors for different clinical manifestations of venous thromboembolism (VTE). This study investigated whether the clinical manifestation of VTE, the extension of deep vein thrombosis (DVT) and the presence of transient risk factors at the time of the first VTE, differed among patients with mutations (97 with FVLeiden; 33 with prothrombin G20210A) and in 109 patients without thrombophilia. Isolated pulmonary embolism (PE) was less prevalent in patients with FVLeiden (6%) and no thrombophilia (6%) than in those with prothrombin G20210A (15%). No difference was found in the incidence of distal DVT. Regarding the extension of proximal DVT, the lowest incidence for isolated popliteal vein and the highest for iliofemoral vein were observed in patients with prothrombin G20210A. No difference was observed between groups of patients with or without thrombophilia by unprovoked VTE. The pregnancy/puerperium was the most prevalent risk factor in carriers of prothrombin G20210A. Among FVLeiden carriers, the most prevalent risk factor was surgery, and in patients without thrombophilia, it was trauma ( P < .05). Thrombosis of the upper limb was more frequent in a group without thrombophilia than in patients with mutations ( P < .01). Transverse sinus venous thrombosis was present only in patients with prothrombin G20210A. Carriers of prothrombin G20210A have an increased risk of developing isolated PE and more severe clinical manifestations than those with FVLeiden or without thrombophilia.
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Biss TT, Brandão LR, Kahr WH, Chan AK, Williams S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol 2008; 142:808-18. [DOI: 10.1111/j.1365-2141.2008.07243.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Constans J, Boulon C, Solanilla A, Conri C. Conséquences thérapeutiques de la mise en évidence d’une thrombophilie. Rev Med Interne 2008; 29:486-90. [DOI: 10.1016/j.revmed.2008.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 12/24/2007] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
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Huisman MV, Klok FA, Karami Djurabi R, Tormene D, Simioni P, Prandoni P. Factor V Leiden is associated with more distal location of deep vein thrombosis of the leg. J Thromb Haemost 2008; 6:544-5. [PMID: 18182032 DOI: 10.1111/j.1538-7836.2007.02883.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Warnaar N, Molenaar IQ, Colquhoun SD, Slooff MJH, Sherwani S, de Wolf AM, Porte RJ. Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review. J Thromb Haemost 2008; 6:297-302. [PMID: 18005235 DOI: 10.1111/j.1538-7836.2008.02831.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) and intracardiac thrombosis (ICT) are rare but potentially lethal complications during orthotopic liver transplantation (OLT). METHODS We aimed to review clinical and pathological correlates of PE and ICT in patients undergoing OLT. A systematic review of the literature was conducted using MEDLINE and ISI Web of Science. RESULTS Seventy-four cases of intraoperative PE and/or ICT were identified; PE alone in 32 patients (43%) and a combination of PE and ICT in 42 patients (57%). Most frequent clinical symptoms included systemic hypotension and concomitant rising pulmonary artery pressure, often leading to complete circulatory collapse. PE and ICT occurred in every stage of the operation and were reported equally in patients with or without the use of venovenous bypass or antifibrinolytics. A large variety of putative risk factors have been suggested in the literature, including the use of pulmonary artery catheters or certain blood products. Nineteen patients underwent urgent thrombectomy or thrombolysis. Overall mortality was 68% (50/74) and 41 patients (82%) died intraoperatively. CONCLUSION Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.
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Affiliation(s)
- N Warnaar
- Section Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Austin H, Key NS, Benson JM, Lally C, Dowling NF, Whitsett C, Hooper WC. Sickle cell trait and the risk of venous thromboembolism among blacks. Blood 2007; 110:908-12. [PMID: 17409269 DOI: 10.1182/blood-2006-11-057604] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
People with sickle cell disease have a chronically activated coagulation system and display hemostatic perturbations, but it is unknown whether they experience an increased risk of venous thromboembolism. We conducted a case-control study of venous thromboembolism that included 515 hospitalized black patients and 555 black controls obtained from medical clinics. All subjects were assayed for hemoglobin S and hemoglobin C genotypes. The prevalence of the S allele was 0.070 and 0.032 for case patients and controls, respectively (P < .001). The odds that a patient had sickle cell trait were approximately twice that of a control, indicating that the risk of venous thromboembolism is increased approximately 2-fold among blacks with sickle cell trait compared with those with the wild-type genotype (odds ratio = 1.8 with 95% confidence interval, 1.2-2.9). The odds ratio for pulmonary embolism and sickle cell trait was higher, 3.9 (2.2-6.9). The prevalence of sickle cell disease was also increased among case patients compared with controls. We conclude that sickle cell trait is a risk factor for venous thromboembolism and that the proportion of venous thromboembolism among blacks attributable to the mutation is approximately 7%.
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Affiliation(s)
- Harland Austin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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