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Eppenberger D, Nilius H, Anagnostelis B, Huber CA, Nagler M. Current Knowledge on Factor V Leiden Mutation as a Risk Factor for Recurrent Venous Thromboembolism: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:883986. [PMID: 35463779 PMCID: PMC9021545 DOI: 10.3389/fcvm.2022.883986] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background Thrombophilia screening is widely done in clinical practice, and it is claimed that the extent of venous thromboembolism (VTE) recurrence risk in patients with common defects is still not fully understood. Aim We aimed to summarize data of all observational studies prospectively assessing the association of heterozygous factor V Leiden (FVL) mutation and recurrent VTE in patients with VTE, and to calculate pooled relative risks (RR), overall and in various subgroups. Methods We searched MEDLINE and EMBASE databases for cohort studies prospectively assessing VTE recurrence in patients with and without FVL mutation (PROSPERO: CRD42021182800). Data were extracted on cohort and study-level. The methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). RR were calculated overall and in subgroups using a random-effects model. Results From 31 cohorts, 24 studies were finally included summarizing 13,571 patients. Heterozygous FVL mutation was identified in 2,840 individuals (21%). The methodological quality was estimated to be high in 20 studies (83%). The overall RR was 1.46 (95% CI: 1.31, 1.64), consistent across subgroups. Conclusions Pooling all high-quality epidemiological data, the risk of recurrent VTE was increased by 46% in patients with heterozygous FVL mutation. Against the background of established risk factors, the FVL mutation plays only a marginal role in the risk assessment for recurrent VTE.
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Affiliation(s)
- Daria Eppenberger
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henning Nilius
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Betsy Anagnostelis
- Medical Library Research Support Service, University Library of Bern, University of Bern, Bern, Switzerland
| | - Carola A. Huber
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Michael Nagler
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Michael Nagler
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Vlieg AVH, Flinterman LE, Bare LA, Cannegieter SC, Reitsma PH, Arellano AR, Tong CH, Devlin JJ, Rosendaal FR. Genetic Variations Associated With Recurrent Venous Thrombosis. ACTA ACUST UNITED AC 2014; 7:806-13. [DOI: 10.1161/circgenetics.114.000682] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background—
The prediction of recurrent venous thrombosis using individual genetic risk predictors has proven to be challenging. The aim of this study was to assess whether multiple genetic single nucleotide polymorphism (SNP) analysis would predict recurrent venous thrombosis.
Methods and Results—
Patients with a first venous thrombosis were followed for a recurrent venous thrombosis up to 2009 (MEGA follow-up study), which occurred in 608 out of 4100 patients (2.7%/year). Thirty-one common thrombosis-associated single nucleotide polymorphisms (SNPs) were associated with the risk of recurrence. A genetic risk score (GRS) for each individual was calculated by summing the number of risk-increasing alleles for each of the 31 SNPs and for a simplified model consisting of 5 SNPs: rs6025, rs1799963, rs8176719, rs2066865, and rs2036914. The risk of recurrence associated with the GRS was calculated continuously and after stratification in a low and high score. All individual SNPs were at most mildly associated with recurrence risk. Regarding the 31-SNP GRS, recurrence risk was highest in patients with ≥31 and lowest in patients with <21 risk alleles. The discriminative power of the 5-SNP GRS was similar to that of the 31-SNP GRS. The 6-year cumulative incidence of recurrence was high for individuals with ≥5 (20.3%; 95% confidence interval, 16.5–24.1) and low for individuals with ≤1 (9.4%; 95% confidence interval, 6.7–12.1) risk alleles. Predictive power improved after stratification into provoked and unprovoked first events and sex.
Conclusions—
Multiple genetic SNP analysis is useful in the prediction of recurrent thrombosis, even more so when combining this model with clinical risk factors.
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Affiliation(s)
- Astrid van Hylckama Vlieg
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Linda E. Flinterman
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Lance A. Bare
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Suzanne C. Cannegieter
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Pieter H. Reitsma
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Andre R. Arellano
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Carmen H. Tong
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - James J. Devlin
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
| | - Frits R. Rosendaal
- From the Department of Clinical Epidemiology (A.v.H.V., L.E.F., S.C.C., F.R.R.), Department of Thrombosis and Haemostasis (P.H.R., F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (A.v.H.V., S.C.C., P.H.R., F.R.R.), Leiden University Medical Center, Leiden, the Netherlands; and Celera, Alameda, CA (L.A.B., A.R.A., C.H.T., J.J.D.)
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Younes S, Aissi M, Chérif Y, Daoussi N, Boughammoura A, Frih Ayed M, Sfar MH, Jerbi S. [Idiopathic intracranial hypertension and factor V Leiden mutation]. JOURNAL DES MALADIES VASCULAIRES 2014; 39:270-273. [PMID: 24908418 DOI: 10.1016/j.jmv.2014.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/17/2014] [Indexed: 06/03/2023]
Abstract
Activated proteinC resistance is a frequent prothrombotic abnormality. In most cases it is due to factorV Leiden mutation by nucleotide G1691A substitution. This recently described thrombophilic defect of activated proteinC resistance has been postulated to be implicated in the pathogenesis of idiopathic intracranial hypertension (IIH). We report a case of factorV Leiden mutation in association with IIH and their likely link and implication in the management of IIH.
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Affiliation(s)
- S Younes
- Service de médecine interne-endocrinologie-neurologie, hôpital universitaire Taher Sfar Mahdia, Hiboun 5111, Tunisie.
| | - M Aissi
- Service de neurologie, hôpital universitaire Fattouma Bourguiba, avenue 1(er)-Juin, Monastir 5000, Tunisie
| | - Y Chérif
- Service de médecine interne-endocrinologie-neurologie, hôpital universitaire Taher Sfar Mahdia, Hiboun 5111, Tunisie
| | - N Daoussi
- Service de neurologie, hôpital universitaire Fattouma Bourguiba, avenue 1(er)-Juin, Monastir 5000, Tunisie
| | - A Boughammoura
- Service de neurologie, hôpital universitaire Fattouma Bourguiba, avenue 1(er)-Juin, Monastir 5000, Tunisie
| | - M Frih Ayed
- Service de neurologie, hôpital universitaire Fattouma Bourguiba, avenue 1(er)-Juin, Monastir 5000, Tunisie
| | - M H Sfar
- Service de médecine interne-endocrinologie-neurologie, hôpital universitaire Taher Sfar Mahdia, Hiboun 5111, Tunisie
| | - S Jerbi
- Service d'imagerie médicale, hôpital universitaire Taher Sfar Mahdia, Hiboun 5111, Tunisie
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Palareti G. Recurrent venous thromboembolism: what is the risk and how to prevent it. SCIENTIFICA 2012; 2012:391734. [PMID: 24278687 PMCID: PMC3820456 DOI: 10.6064/2012/391734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/10/2012] [Indexed: 05/07/2023]
Abstract
Venous thromboembolism (VTE) that includes deep vein thrombosis and/or pulmonary embolism is a frequent, severe, and potentially lethal disease. After a first episode, VTE has a strong tendency to recur. While VTE is an acute disease, it may have variable outcomes in early and late phases after initial presentation. Furthermore, the incidence of late, clinically important consequences (postthrombotic syndrome and/or chronic thromboembolic pulmonary hypertension) increases in case of recurrent events. The aims of the present review are (i) to analyze the incidence and risk factors for recurrence of VTE (either those related to the type of first thrombotic event or to the patients), the risks associated with occurrence of recurrent events, and the problems linked to the diagnosis, not always easy, of recurrent events; (ii) to discuss whether or not it is possible to predict the individual risk of recurrence after a first event, by stratifying patients at high or low risk of recurrence, and how this can influence their treatment; (iii) to comment what the current guidelines and guidance suggest/recommend about anticoagulant treatment after a first VTE event and, finally, to propose practical indications on how to manage individual patients affected by VTE.
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Affiliation(s)
- Gualtiero Palareti
- Department of Angiology and Blood Coagulation, Via Albertoni 15, 40138 Bologna (BO), Italy
- *Gualtiero Palareti:
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