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Oliver WM, Mackenzie SA, Lenart L, McCann CJ, Mackenzie SP, Duckworth AD, Clement ND, White TO, Maempel JF. Age, personal and family history are independently associated with venous thromboembolism following acute Achilles tendon rupture. Injury 2022; 53:762-770. [PMID: 34689989 DOI: 10.1016/j.injury.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/29/2021] [Accepted: 10/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim was to determine independent patient, injury and management-related factors associated with symptomatic venous thromboembolism (VTE) following acute Achilles tendon rupture (ATR). The secondary aim was to suggest a clinical VTE risk assessment tool for patients with acute ATR. METHODS From 2010-2018, 984 consecutive adults (median age 47yrs, 73% [n = 714/984] male) sustaining an acute ATR were retrospectively identified. Ninety-five percent (n = 939/984) were managed non-operatively in a below-knee cast (52%, n = 507/984) or walking boot (44%, n = 432/984), with 5% (n = 45/984) undergoing primary operative repair (<6wks post-injury). VTE was diagnosed using local medical records and national imaging archives, reviewed at a mean 5yrs (range 1-10) post-injury. Multivariate logistic regression was performed to determine independent factors associated with VTE. RESULTS The incidence of VTE within 90 days of ATR was 3.6% (n = 35/984; deep vein thrombosis 2.1% [n = 21/984], pulmonary embolism 1.9% [n = 19/984]), and the median time to VTE was 24 days (interquartile range 15-44). Age ≥50yrs (adjusted OR [aOR] 2.3, p = 0.027), personal history of VTE/thrombophilia (aOR 6.1, p = 0.009) and family history of VTE (aOR 20.9, p<0.001) were independently associated with VTE following ATR. These non-modifiable risk factors were incorporated into a VTE risk assessment tool. Only 23% of patients developing VTE (n = 8/35) had a relevant personal or family history, but incorporating age ≥50yrs into the VTE risk assessment tool (alongside personal and family history) identified 69% of patients with VTE (n = 24/35). Non weight-bearing for ≥2wks after ATR was also independently associated with VTE (aOR 3.2, p = 0.026). CONCLUSIONS Age ≥50 years, personal history of VTE/thrombophilia and a positive family history were independently associated with VTE following ATR. Incorporating age into our suggested VTE risk assessment tool enhanced its sensitivity in identifying at-risk patients. Early weight-bearing in an appropriate orthosis may be beneficial to all patients in VTE risk reduction.
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Samuel A Mackenzie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Lucia Lenart
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Conor J McCann
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Samuel P Mackenzie
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom; Centre for Population Health Sciences, Usher Institute, University of Edinburgh, 49 Little France Crescent, EH16 4SB, United Kingdom.
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian, EH16 4SA, United Kingdom.
| | - Julian F Maempel
- Department of Trauma, Orthopaedics and Sports Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta; University of Malta Medical School, University of Malta, Msida, MSD 2090, Malta.
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Benhamou Y, Delluc A, Mauge L, Fischer AM, Sanchez O. [Which aetiological investigations to undertake during the progress of PE/DVT?]. Rev Mal Respir 2021; 38 Suppl 1:e90-e98. [PMID: 33744073 DOI: 10.1016/j.rmr.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Y Benhamou
- Service de médecine interne, CHU Charles-Nicolle, Normandie université UNI Rouen U1096, 76000 Rouen, France
| | - A Delluc
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; EA 3878 GETBO, université de Bretagne occidentale, 29200 Brest, France
| | - L Mauge
- UMR-S 970, PARCC (Paris-Cardiovascular Research Center), service d'hématologie biologique, hôpital européen Georges-Pompidou, Assistance publique Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - A-M Fischer
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Service d'hématologie biologique hôpital européen Georges-Pompidou, Assistance publique des hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 St-Étienne cedex 2, France; Inserm UMRS 1140, service de pneumologie et de soins intensifs, hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France.
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Pannucci CJ. Venous Thromboembolism in Aesthetic Surgery: Risk Optimization in the Preoperative, Intraoperative, and Postoperative Settings. Aesthet Surg J 2019; 39:209-219. [PMID: 29846505 DOI: 10.1093/asj/sjy138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this Continuing Medical Education (CME) article is to provide a framework for practicing surgeons to conceptualize and quantify venous thromboembolism risk among the aesthetic and ambulatory surgery population. The article provides a practical approach to identify and minimize venous thromboembolism risk in the preoperative, intraoperative, and postoperative settings.
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Affiliation(s)
- Christopher J Pannucci
- Division of Plastic Surgery, Division of Health Services Research, at the University of Utah, Salt Lake City, UT
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Li X, Ohlsson H, Ji J, Sundquist J, Sundquist K, Zöller B. Family history of venous thromboembolism as a risk factor and genetic research tool. Thromb Haemost 2017; 114:890-900. [DOI: 10.1160/th15-04-0306] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/03/2015] [Indexed: 12/25/2022]
Abstract
SummaryFamilial clustering of venous thromboembolism (VTE) was described as far back as 1905 by Briggs. Although Egeberg discovered inherited deficiency of antithrombin in 1965, it was not until Dahlback discovered resistance to activated protein C in 1993 that it became clear that genetic factors are common risk factors of VTE. Several genes have been linked to familial aggregation of VTE and genome-wide association studies have found several novel gene loci. Still, it has been estimated that much of the heritability for VTE remains to be discovered. Family history (FH) of VTE is therefore still important to determine whether a patient has an increased genetic risk of VTE. FH has the potential to represent the sum of effects and interactions between environmental and genetic factors. In this article the design, methodology, results, clinical and genetic implications of FH studies of VTE are reviewed. FH in first-degree relatives (siblings and/or parents) is associated with a 2–3 times increased familial relative risk (FRR). However, the FRR is dependent on age, number of affected relatives, and presentation of VTE (provoked/unprovoked). Especially high familial risks are observed in individuals with two or more affected siblings (FFR> 50). However, the familial risk for recurrent VTE is much lower or non-significant. Moreover, FH of VTE appears mainly to be important for venous diseases (i. e. VTE and varicose veins). The familial associations with other diseases are weaker. In conclusion, FH of VTE is an important research tool and a clinically potential useful risk factor for VTE.
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Rossi E, Ciminello A, Za T, Betti S, Leone G, Stefano V. In families with inherited thrombophilia the risk of venous thromboembolism is dependent on the clinical phenotype of the proband. Thromb Haemost 2017; 106:646-54. [DOI: 10.1160/th11-02-0080] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 07/08/2011] [Indexed: 11/05/2022]
Abstract
SummaryThe utility of laboratory investigation of relatives of individuals with inherited thrombophilia is uncertain. To assess the risk of venous thromboembolism (VTE) among the carriers, we investigated a family cohort of 1,720 relatives of probands with thrombophilia who were evaluated because of VTE (n=1,088), premature arterial thrombosis (n=113), obstetric complication (n=257), or universal screening before pregnancy or hormonal contraception or therapy (n=262); 968 relatives were carriers of thrombophilia. A first deep venous thrombosis (DVT) occurred in 44 carriers and 10 non-carriers during 37,688 and 29,548 observationyears from birth, respectively. The risk of DVT among the carriers compared with non-carriers was estimated as a hazard ratio (HR). If the proband had VTE and factor V Leiden (FVL) and/or prothrombin (PT)20210A, the HR for DVT was 2.77 (95%CI 1.21–4.82) in the carriers overall, and 5.54 (95%CI 3.20–187.00) in those homozygous or double heterozygous for FVL and PT20210A. If the proband had VTE and a deficiency of antithrombin (AT), protein C or S, the HR for DVT was 5.14 (95%CI 0.88–10.03) in the carriers overall, and 12.86 (95%CI 2.46–59.90) in those with AT deficiency. No increase in risk was found among the carriers who were relatives of the probands who were evaluated for reasons other than VTE. In conclusion, familial investigation for inherited thrombophilia seems justified for probands with previous VTE, but appears of doubtful utility for the relatives of probands without VTE. This should be taken with caution regarding families with deficiency of natural anticoagulants, given the low number of cases analysed.
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Li X, Sundquist J, Sundquist K, Zöller B. Determination of age-specific and sex-specific familial risks for the different manifestations of venous thromboembolism: A nationwide family study in Sweden. Thromb Haemost 2017; 106:102-12. [DOI: 10.1160/th10-10-0655] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 04/01/2010] [Indexed: 01/07/2023]
Abstract
SummaryThis nationwide study aimed to determine whether differences exist in age-specific and sex-specific familial risks for pulmonary embolism (PE), venous thrombosis of the lower limbs (VT) and other forms of venous thromboembolism (OVTE) among offspring, siblings and spouses of affected individuals. The Swedish Multi-Generation Register was linked to the Hospital Discharge Register data for the period 1987–2007. Standardised incidence ratios (SIRs) were calculated for individuals whose relatives were hospitalised for venous thromboembolism (VTE), as determined by the International Classification of Diseases (ICD), and those whose relatives were unaffected by VTE. The total number of hospitalised VTE patients was 45,362. All VTE patients were categorised as PE, VT or OVTE according to ICD at first hospitalisation. For example, the parental SIRs for PE, VT and OVTE in offspring at age 10–19 years were 2.89 (95% CI 1.48–5.06), 4.99 (95% CI 3.22–6.10) and 3.89 (95% CI 2.51–5.75), respectively. The low spousal risks of PE (1.08; 95% CI 1.02–1.13), VT (1.06; 95% CI 1.011.12) and OVTE (1.07; 95% CI 1.00–1.15) suggest the familial risks to be largely genetic. In both men and women, familial relative risks were increased for all the different manifestations of VTE with the exception of those older than 70 years. Familial history is a risk indicator in both sexes, and is potentially useful for clinical risk assessment for the different manifestations of VTE.
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Sindet-Pedersen C, Bruun Oestergaard L, Gundlund A, Fosbøl EL, Aasbjerg K, Langtved Pallisgaard J, Gislason G, Torp-Pedersen C, Bjerring Olesen J. Familial Clustering of Venous Thromboembolism - A Danish Nationwide Cohort Study. PLoS One 2016; 11:e0169055. [PMID: 28033406 PMCID: PMC5199093 DOI: 10.1371/journal.pone.0169055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES To examine the relative rate of VTE in first-degree relatives compared with the general population. METHODS By crosslinking Danish nationwide registries we identified patients with VTE between 1978 and 2012, and their familial relations. The first member in a family to acquire VTE was defined as the proband. All first-degree relatives to probands were followed from the VTE date of the proband and until an event (VTE), death, emigration, 100 year birthday or end of study: 31st of December 2012, whichever came first. The relative rate of VTE was estimated by standardized incidence ratios (SIR) using time-dependent Poisson regression models, with the general population as a fixed reference. RESULTS We identified 70,767 children of maternal probands, 66,065 children of paternal probands, and 29,183 siblings to sibling probands. Having a maternal proband or a paternal proband were associated with a significantly increased VTE rate of 2.15 (CI: 2.00-2.30) and 2.06 (CI: 1.92-2.21), respectively. The highest estimate of VTE was observed among siblings (adjusted SIR of 2.60 [CI: 2.38-2.83]). Noteworthy, the rate of VTE increased for all first-degree relatives when the proband was diagnosed with VTE in a young age (≤ 50 years). CONCLUSION A family history of VTE was associated with a significantly increased rate of VTE among first-degree relatives compared with the general population.
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Affiliation(s)
- Caroline Sindet-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- * E-mail:
| | - Louise Bruun Oestergaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Anna Gundlund
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Emil Loldrup Fosbøl
- The Danish Heart Foundation, Copenhagen K, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø, Denmark
| | - Kristian Aasbjerg
- Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Jannik Langtved Pallisgaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- The Danish Heart Foundation, Copenhagen K, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
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Zöller B, Ohlsson H, Sundquist J, Sundquist K. Family history of venous thromboembolism is a risk factor for venous thromboembolism in combined oral contraceptive users: a nationwide case-control study. Thromb J 2015; 13:34. [PMID: 26500457 PMCID: PMC4617955 DOI: 10.1186/s12959-015-0065-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim was to assess the risk of venous thromboembolism (VTE) associated with use of combined oral contraceptives (COCs) in women with a family history of VTE. METHODS The study is a Swedish nationwide case-control study based on the Multigeneration register, the Swedish Hospital Discharge Register, the Outpatient Care Register, and the Swedish Prescribed Drug Register. Cases (n = 2,311) were non-pregnant Swedish women aged 15-49 with first VTE diagnoses between January 2006 and December 2010. Five controls without VTE were matched to each case on age and education level. Conditional logistic regression examined the associations with VTE with determination of odds ratio (OR) for first VTE diagnosis. Effect modification was assessed by interaction testing. RESULTS Both among controls (14.6 % vs. 4.5 %; p < 0.0001) and cases (27.2 % vs. 8.8 %; p < 0.0001) COC use was more common in women without a family history of VTE compared with women with a family history of VTE. In a multivariate conditional logistic regression model the OR for VTE was 2.53 (95 % CI 2.23-2.87) for COC users and 2.38 (2.09-2.71) for individuals with a family history of VTE. The OR for VTE for COC users with a family history of VTE was 6.02 (5.02-7.22). There was no significant interaction between family history of VTE and COC use (OR 0.92, 0.57-1.46). CONCLUSIONS Family history of VTE is a risk factor for VTE in women using COCs. The low prevalence of COC use among women with a family history of VTE suggests that family history of VTE is considered when COCs are prescribed in Sweden. The present study may therefore even underestimate the importance of family history of VTE. The lack of interaction indicates that the risk of COC use in women with family history of VTE is determined by the product of the ORs for family history and COC use.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, CRC, Building 28, Floor 11, Jan Waldenströms gata 35, S-205 02 Malmö, Sweden
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, CRC, Building 28, Floor 11, Jan Waldenströms gata 35, S-205 02 Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, CRC, Building 28, Floor 11, Jan Waldenströms gata 35, S-205 02 Malmö, Sweden ; Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, CRC, Building 28, Floor 11, Jan Waldenströms gata 35, S-205 02 Malmö, Sweden ; Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA USA
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How to avoid venous thromboembolism in women at increased risk – with special focus on low-risk periods. Thromb Res 2015; 136:513-8. [DOI: 10.1016/j.thromres.2015.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/04/2015] [Accepted: 06/15/2015] [Indexed: 12/28/2022]
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Zöller B, Palmer K, Li X, Sundquist J, Sundquist K. Family history of venous thromboembolism and risk of hospitalized thromboembolism in cancer patients: A nationwide family study. Thromb Res 2015; 136:573-81. [DOI: 10.1016/j.thromres.2015.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/23/2015] [Accepted: 07/08/2015] [Indexed: 12/21/2022]
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Horellou MH, Plu-Bureau G, Lepercq J. [Venous thromboembolism and pregnancy]. Rev Med Interne 2014; 36:219-24. [PMID: 25475826 DOI: 10.1016/j.revmed.2014.10.356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 10/20/2014] [Indexed: 12/15/2022]
Abstract
Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during or early after pregnancy. Prior VTE or family history of VTE, clinical or biological risk factors increased the risk of pregnancy-related VTE. Defining the risk of VTE before or at the beginning of pregnancy is necessary to propose the best prevention. However, the management is not standardized between physicians, centres and countries. Current guidelines for prophylaxis and treatment of VTE are discussed in this review.
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Affiliation(s)
- M-H Horellou
- Service d'hématologie biologique, hôpitaux universitaires Paris Centre-Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex14, France; Faculté de médecine Paris-Descartes, France.
| | - G Plu-Bureau
- Faculté de médecine Paris-Descartes, France; Service de gynécologie médicale, hôpitaux universitaires Paris Centre-Cochin, Paris, France
| | - J Lepercq
- Faculté de médecine Paris-Descartes, France; Service d'obstétrique, hôpitaux universitaires Paris Centre-Cochin, Paris, France
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Zöller B, Ji J, Sundquist J, Sundquist K. Venous thromboembolism and varicose veins share familial susceptibility: a nationwide family study in Sweden. J Am Heart Assoc 2014; 3:jah3641. [PMID: 25158864 PMCID: PMC4310366 DOI: 10.1161/jaha.114.000850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Varicose veins (VVs) have been associated with venous thromboembolism (VTE), but whether these diseases share familial susceptibility has not been determined. This nationwide study aimed to determine whether VTE shares familial susceptibility with VVs. Methods and Results Swedish Multigeneration Register data for persons aged 0 to 76 years during the period 1964–2008 were linked to the Swedish Inpatient and Outpatient Registers. Familial risks (standardized incidence ratios [SIRs]) of VTE and VVs were examined in 2 ways (ie, bidirectionally): risk of VTE in subjects whose siblings had been diagnosed with VVs and risk of VVs in persons whose siblings had been diagnosed with VTE. The analyses were repeated for spouses to determine the importance of shared adult family environment. In total, 96 810 siblings had VVs and 87 564 had VTE. An increased risk of VTE was observed in persons whose siblings had VVs (SIR 1.30, 95% CI 1.26 to 1.33), whereas persons whose siblings had VTE had an increased risk of VVs (SIR 1.30, 95% CI 1.27 to 1.34). If 2 or more siblings were affected by VTE, the risk for VVs was 1.70 (95% CI 1.53 to 1.88). Conversely, if 2 or more siblings were affected by VVs, the risk for VTE was 1.52 (95% CI 1.38 to 1.67). In spouses of VTE patients, a minor increased risk of VVs was observed (SIR 1.05 for husbands, SIR 1.06 for wives). The risk of VTE in spouses of VV patients was similarly small (SIR 1.01 for husbands, SIR 1.05 for wives). Conclusions VVs and VTE share familial susceptibility. This novel finding suggests the existence of shared familial and possibly genetic factors.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden (B., J.J., J.S., K.S.)
| | - Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden (B., J.J., J.S., K.S.)
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden (B., J.J., J.S., K.S.) Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden (B., J.J., J.S., K.S.) Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
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Zöller B, Li X, Sundquist J, Sundquist K. Familial Transmission of Venous Thromboembolism. ACTA ACUST UNITED AC 2014; 7:296-303. [DOI: 10.1161/circgenetics.113.000341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Venous thromboembolism (VTE) clusters in families, but the familial risk of VTE has not been determined among adoptees. The aim was to disentangle the contributions of genetic and environmental factors to the familial transmission of VTE.
Methods and Results—
The Swedish Multi-Generation Register was used to follow all Swedish-born adoptees born from 1932 to 2004 (n=80,214) between January 1, 1964, and December 31, 2010, for VTE. The risk of VTE was estimated in adoptees with ≥1 biological parent with VTE compared with adoptees without a biological parent with VTE. The risk of VTE was also estimated in adoptees with ≥1 adoptive parent with VTE compared with adoptees without an adoptive parent with VTE. Adoptees with ≥1 biological parent with VTE (n=137) were more likely to have VTE than adoptees without a biological parent with VTE (standardized incidence ratio) 1.51 (95% confidence interval, 1.27–1.79). The standardized incidence ratio for VTE was highest for adoptees with a biological parent diagnosed with VTE before the age of 50 years (standardized incidence ratio=2.03, 1.24–3.14). In contrast, adoptees with ≥1 adoptive parent with VTE (n=156) were not at increased risk of VTE (standardized incidence ratio=1.07, 0.91–1.25).
Conclusions—
These novel findings suggest that genetic factors make a stronger contribution to the familial transmission of VTE from parents to offspring than family environmental factors.
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Affiliation(s)
- Bengt Zöller
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden (B.Z., X.L., J.S., K.S.); and Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
| | - Xinjun Li
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden (B.Z., X.L., J.S., K.S.); and Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
| | - Jan Sundquist
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden (B.Z., X.L., J.S., K.S.); and Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
| | - Kristina Sundquist
- From the Center for Primary Health Care Research, Lund University, Malmö, Sweden (B.Z., X.L., J.S., K.S.); and Stanford Prevention Research Centre, Stanford University School of Medicine, Stanford, CA (J.S., K.S.)
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Zöller B, Ohlsson H, Sundquist J, Sundquist K. Family history of venous thromboembolism (VTE) and risk of recurrent hospitalization for VTE: a nationwide family study in Sweden. J Thromb Haemost 2014; 12:306-12. [PMID: 24382197 DOI: 10.1111/jth.12499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data concerning the importance of a family history of venous thromboembolism (VTE) for the risk of recurrent VTE are sparse. The aim of this nationwide study was to determine whether a family history of VTE is a risk factor for recurrent hospitalization for unprovoked VTE (deep vein thrombosis of the lower extremities or pulmonary embolism). METHODS We linked Multigeneration Register data on individuals aged 0-77 years to the Swedish nationwide Hospital Discharge Register data for the period 1987-2009 to compare the risk of hospitalization for unprovoked recurrent VTE among individuals with and without a parental or sibling history of VTE. We calculated hazard ratios (HRs) to determine the familial HR for recurrent hospitalization for VTE. RESULTS AND CONCLUSIONS The risk of recurrent VTE hospitalization was 1.20 (95% confidence interval [CI] 1.10-1.32) for individuals with affected parents, and 1.30 (95% CI 1.14-1.49) for those with affected siblings. The risk of recurrent VTE hospitalization in individuals with two affected parents was 1.92 (95% CI 1.44-2.58). There was an interaction between age at diagnosis of VTE and a family history of VTE, with a family history having a stronger effect on VTE risk in younger patients. We conclude that a family history of VTE is a modest risk factor for recurrent VTE hospitalization in Sweden.
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Affiliation(s)
- B Zöller
- Center for Primary Health Care Research, Region Skåne/Lund University, Malmö, Sweden
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16
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De Stefano V, Grandone E, Martinelli I. Recommendations for prophylaxis of pregnancy-related venous thromboembolism in carriers of inherited thrombophilia. Comment on the 2012 ACCP guidelines. J Thromb Haemost 2013; 11:1779-81. [PMID: 23789890 DOI: 10.1111/jth.12330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Indexed: 11/30/2022]
Affiliation(s)
- V De Stefano
- Institute of Hematology, Department of Medical Sciences, Catholic University, Rome, Italy
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17
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Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 2013; 28:621-47. [PMID: 23900608 PMCID: PMC3935237 DOI: 10.1007/s10654-013-9825-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 07/02/2013] [Indexed: 12/16/2022]
Abstract
Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.
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Affiliation(s)
- B Simone
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - V De Stefano
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E Leoncini
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - J Zacho
- Department of Clinical Biochemistry, Herlev Hospital,
Copenhagen University Hospital, Herlev, Denmark
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center,
Department of Internal Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda
- Ospedale Maggiore Policlinico, Milan, Italy
| | - J Emmerich
- Hôpital Européen Georges Pompidou, Service
de Médecine Vasculaire, Centre Claude Bernard et Laboratoire
d'Hémostase, Paris, France
| | - E Rossi
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - AR Folsom
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, MN, USA
| | - WY Almawi
- Department of Medical Biochemistry, Arabian Gulf
University, Manama, Bahrain
| | | | - M den Heijer
- Department of Internal Medicine, VU Medical Center, PO-box
7057 1007 MB, Amsterdam, the Netherlands
| | - M Cushman
- Department of Medicine, University of Vermont,
Burlington 05446, USA
| | - S Penco
- Medical Genetics, Clinical Chemistry and Clinical
Pathology Laboratory, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3,
20100 Milan, Italy
| | - A Vaya
- Thrombosis and Hemostasis Unit, Department of Clinical
Pathology, La Fe University Hospital, Valencia, Spain
| | - P Angchaisuksiri
- Department of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
| | - G Okumus
- Department of Pulmonary Diseases, Istanbul Medical
Faculty, Istanbul University, Capa-Istanbul, Turkey
| | - D Gemmati
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - S Cima
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - N Akar
- Ankara University Department of Pediatric Molecular
Genetics, Ankara, Turkey
| | - KI Oguzulgen
- Department of Pulmonary Medicine, Gazi University School
of Medicine, Ankara, Turkey
| | - V Ducros
- Département de Biochimie, Toxicologie et
Pharmacologie, Centre Hospitalier Universitaire, BP 217, 38043 Grenoble,
France
| | - C Lichy
- Department of Neurology, Klinikum Memmingen,
Bismarckstrasse 23, 87700 Memmingen, Germany
| | - C Fernandez-Miranda
- Servicio de Medicina Interna, Hospital Universitario 12
de Octubre, Madrid, Spain
| | - A Szczeklik
- Dept of Medicine, Jagiellonian University School of
Medicine, Cracow, Poland
| | - JA Nieto
- Departments of Internal Medicine, Virgen de la Luz
Hospital, Cuenca, Spain
| | - JD Torres
- Grupo de Investigación en Trombosis, Universidad
de Antioquia–Hospital Universitario San Vicente de Paúl,
Medellín, Colombia
| | | | - P Ivanov
- Department of Biochemistry, University of Medicine,
Pleven, Bulgaria
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Neurología y
Neurocirugía Manuel Velasco Suárez, Mexico
| | - VM Shmeleva
- Russian Institute of Haematology and Transfusion, St.
Petersburg, 2-nd Sovietskaya 16, Russia
| | - M Stegnar
- Department of Vascular Diseases, University Medical
Centre Ljubljana, Ljubljana, Slovenia
| | - D Ogunyemi
- Perinatology Unit, Morristown Memorial Hospital, New
Jersey, USA
| | - SS Eid
- King Hussein Medical Center, Princess Iman Research
Center for Laboratory Sciences, Amman, Jordan
| | - N Nicolotti
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E De Feo
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - S Boccia
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
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De Stefano V, Rossi E. Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. A review of the Guidelines from Scientific Societies and Working Groups. Thromb Haemost 2013; 110:697-705. [PMID: 23846575 DOI: 10.1160/th13-01-0011] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/13/2013] [Indexed: 11/05/2022]
Abstract
The clinical penetrance of venous thromboembolism (VTE) susceptibility genes is variable, being lower in heterozygous carriers of factor V Leiden and prothrombin 20210A (mild thrombophilia), and higher in the rare carriers of deficiencies of antithrombin, protein C or S, and those with multiple or homozygous abnormalities (high-risk thrombophilia). The absolute risk of VTE is low, and the utility of laboratory investigation for inherited thrombophilia in patients with VTE and their asymptomatic relatives has been largely debated, leading to the production of several Guidelines from Scientific Societies and Working Groups. The risk for VTE largely depends on the family history of VTE. Therefore, indiscriminate search for carriers is of no utility, and targeted screening is potentially more fruitful. In patients with VTE inherited thrombophilia is not scored as a determinant of recurrence, playing a minor role in the decision of prolonging anticoagulation; indeed, a few guidelines consider testing worthwhile to identify carriers of high-risk thrombophilia, particularly those with a family history of VTE. The identification of the asymptomatic carrier relatives of the probands with VTE and thrombophilia could reduce cases of provoked VTE, offering them primary antithrombotic prophylaxis during risk situations. In most guidelines, this is considered justified only for relatives of probands with a deficiency of natural anticoagulants or multiple abnormalities. Counselling the asymptomatic female relatives of individuals with VTE and/or thrombophilia before pregnancy or the prescription of hormonal treatments should be administered with consideration of the risk driven by the type of thrombophilia and the family history of VTE.
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Affiliation(s)
- Valerio De Stefano
- Valerio De Stefano, MD, Institute of Hematology, Catholic University, Largo Gemelli 8, 00168 Rome, Italy, Tel.: +39 06 30154968, Fax: +39 06 30154206, E-mail:
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Zöller B, Li X, Sundquist J, Sundquist K. Venous thromboembolism does not share strong familial susceptibility with pre-eclampsia/eclampsia: a nationwide family study in Sweden. BJOG 2013; 120:1200-6. [PMID: 23906308 DOI: 10.1111/1471-0528.12216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Genetic variants associated with venous thromboembolism (VTE) have been suggested to be involved in the pathogenesis of pre-eclampsia/eclampsia (PEC/EC). This nationwide study aimed to determine whether VTE shares familial susceptibility with PEC/EC. DESIGN Population-based cohort study. SETTING Sweden. SAMPLE A total of 941 841 Swedish women delivering their first child between 1987 and 2008. METHODS Data from the Swedish Multigeneration Register were linked to the Swedish Hospital Discharge Register. The risk of PEC/EC was determined in primiparous women with a family history of VTE (in parents and/or siblings), compared with primiparous women without a family history of VTE. Odds ratios (ORs) were calculated by logistic regression. MAIN OUTCOME MEASURE PEC/EC in first pregnancy. RESULTS In total, 43 621 women had PEC/EC in association with their first pregnancy. The OR for PEC/EC in women with a family history of VTE was 1.06 (95% CI 1.01-1.11); however, a family history of VTE was associated with higher odds of PEC/EC among women with previous hypertension (OR 1.38, 95% CI 1.25-1.52). CONCLUSION A family history of VTE is weakly associated with PEC/EC risk, and is not clinically useful for the prediction of PEC/EC. The results of the present study suggest that it is unlikely that strong disease-causing mutations shared by VTE and PEC/EC are common in the Swedish population. The novel association between family history and PEC/EC among the subgroup with previous hypertension needs further confirmation in future studies.
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Affiliation(s)
- B Zöller
- Centre for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
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Zöller B, Ohlsson H, Sundquist J, Sundquist K. Familial risk of venous thromboembolism in first-, second- and third-degree relatives: a nationwide family study in Sweden. Thromb Haemost 2013; 109:458-63. [PMID: 23348971 DOI: 10.1160/th12-10-0743] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/21/2012] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism (VTE) clusters in families, but the familial risk of VTE has only been determined in first-degree relatives. This nationwide study aimed to determine the familial risk of VTE in first-, second- and third-degree relatives of affected individuals. The Swedish Multi-Generation Register was linked to Hospital Discharge Register data for the period 1987-2009. This was a case-cohort study. Odds ratios (ORs) for VTE were calculated for individuals whose relatives were hospitalised for VTE, as determined by the International Classification of Diseases (ICD), and those whose relatives were unaffected by VTE. The familial OR for VTE was 2.49 in siblings (95% confidence interval [CI] 2.40-2.58), 2.65 in children (2.50-2.80), 2.09 in parents (2.03-2.15), 1.52 in maternal half-siblings (1.26-1.85), 2.34 in paternal half-siblings (2.00-2.73), 1.69 in nieces/nephews (1.57-1.82), 1.47 in cousins (1.33-1.64), and 1.14 in spouses of individuals diagnosed with VTE (1.09-1.18). Familial clustering was stronger at young ages. The familial transmission was slightly stronger for males compared with females but was only significant for siblings 1.13 (1.05-1.22) and parents 1.11 (1.05-1.78) of probands. The present data showing an increased VTE risk among not only first-degree relatives but also second- and third-degree relatives indicate that the genetic component of the familial clustering of VTE is strong. Family history is a potentially useful genetic surrogate marker for clinical VTE risk assessment, even in second- and third degree-relatives.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, CRC, building 28, floor 11, Jan Waldenströms gata 35, Skåne University Hospital, S-205 02 Malmö, Sweden.
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Doessegger L, Mahler HC, Szczesny P, Rockstroh H, Kallmeyer G, Langenkamp A, Herrmann J, Famulare J. The potential clinical relevance of visible particles in parenteral drugs. J Pharm Sci 2012; 101:2635-44. [PMID: 22628244 DOI: 10.1002/jps.23217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 05/03/2012] [Accepted: 05/08/2012] [Indexed: 01/16/2023]
Abstract
Visible particulates (VP) are one subclass of defects seen during the final visual inspection of parenteral products and are currently one of the top ten reasons for recalls 1,2. The risk posed by particles is still unclear with limited experience reported in humans but remains an important consideration during the manufacture and use of parenteral products. From the experimental and clinical knowledge of the distribution of particulate matter in the body, clinical complications would include events occurring around parenteral administration e.g., as a result of mechanical pulmonary artery obstruction and injection site reaction, or sub-acute or chronic events e.g., granuloma. The challenge is to better understand the implication for patients of single vials with VP and align the risk with the probabilistic detection process used by manufacturers for accept/reject decisions of individual units of product.
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Affiliation(s)
- Lucette Doessegger
- Pharma Development Safety Risk Management, F. Hoffmann-La Roche AG, Basel, Switzerland.
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Zöller B, Li X, Sundquist J, Sundquist K. Socioeconomic and occupational risk factors for venous thromboembolism in Sweden: A nationwide epidemiological study. Thromb Res 2012; 129:577-82. [DOI: 10.1016/j.thromres.2011.07.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/30/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
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Zöller B, Li X, Sundquist J, Sundquist K. A nationwide family study of pulmonary embolism: identification of high risk families with increased risk of hospitalized and fatal pulmonary embolism. Thromb Res 2012; 130:178-82. [PMID: 22386135 DOI: 10.1016/j.thromres.2012.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/13/2012] [Accepted: 02/06/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Family history is an important risk factor for deep venous thrombosis. However, few studies have determined the importance of family history of pulmonary embolism (PE). OBJECTIVE This nationwide study aimed to determine the familial risks of fatal and hospitalized PE. METHODS The Swedish Multi-Generation Register for subjects aged 0 to 76 years old born since 1932 were linked to the Hospital Discharge Register and Cause of Death Register for the period 1964-2008. Standardized incidence ratios (SIRs) for first hospitalization or death (without previous hospitalization for PE) with a main diagnosis of PE were calculated for individuals whose parent or siblings were hospitalized with or died from PE, compared to those whose parent or siblings were not affected by PE. RESULTS A total of 20,860 individuals were hospitalized for PE and 862 died due to primary fatal PE (without previous hospitalization for PE). The familial SIR for individuals with one sibling with hospitalized PE was 2.49 (95% CI 1.62-3.83). The familial SIR for siblings with two affected probands was 114.29 (95% CI 56.57-223.95). The familial SIRs for individuals with a parent or sibling hospitalized for PE were significantly increased for fatal PE (1.76; 95% CI 1.38-2.21) and hospitalized PE (2.13; 95% CI 2.04-2.23). Spouses had low overall familial risk for PE (1.09; 95% CI, 1.03-1.14). CONCLUSION The high familial risk in multiplex sibling families suggests the existence of strong genetic risk factors for PE. Familial factors and possibly genetic factors are important risk factors for primary fatal pulmonary embolism.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
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Villani M, Tiscia GL, Margaglione M, Colaizzo D, Fischetti L, Vergura P, Grandone E. Risk of obstetric and thromboembolic complications in family members of women with previous adverse obstetric outcomes carrying common inherited thombophilias. J Thromb Haemost 2012; 10:223-8. [PMID: 22136658 DOI: 10.1111/j.1538-7836.2011.04583.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Factor (F)V Leiden and the prothrombin 20210A mutation (PTm) are associated with the occurrence of obstetric complications, including pregnancy-related venous thromboembolism (VTE). It is not known whether family members of women with FV Leiden or PTm and previous obstetric complications have a higher risk of VTE or adverse obstetric outcomes. METHODS A retrospective family study including 563 relatives of 177 women with previous adverse outcomes carrying FV Leiden or PTm, referred between April 1993 and June 2010. A history of obstetric complications and VTE was obtained. Prevalence of VTE and obstetric complications in relatives with and without inherited thrombophilias was compared. Adjusted odd ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models that controlled for predictors (age, FV Leiden and PTm). RESULTS Relatives carrying FV Leiden had a significant and independent risk for obstetric complications (OR: 1.98, 95% CI 1.03-3.83); this risk was not observed in the presence of PTm (OR: 1.03, 95% CI 0.46-2.32). The presence of FV Leiden or PTm in heterozygosis was significantly and independently associated with the occurrence of VTE (OR: 5.2, 95% CI: 1.70-15.91). Severe thrombophilias were strong risk factors for VTE (OR: 23.2, 95% CI: 6.0-89.85). Male gender was a significant and independent risk factor for VTE (OR: 3.49, 95% CI: 1.51-8.05). The risk did not change when relatives of women with a previous pregnancy-related VTE were excluded (OR: 3.49, 95% CI: 1.51-8.05). CONCLUSIONS Knowledge of thrombophilia status may help to better define the obstetric and thromboembolic risks in asymptomatic family members of women who suffered from obstetric complications.
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Affiliation(s)
- M Villani
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, FOGGIA, Italy
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Zöller B, Li X, Sundquist J, Sundquist K. Shared familial aggregation of susceptibility to different manifestations of venous thromboembolism: a nationwide family study in Sweden. Br J Haematol 2011; 157:146-8. [PMID: 22053747 DOI: 10.1111/j.1365-2141.2011.08927.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The incidence of venous thrombosis (VTE) varies by race, with African-Americans having over 5-fold greater incidence than Asian-ancestry populations, and an intermediate risk for European and Hispanic populations. Known racial differences in genetic polymorphisms associated with thrombosis do not account for this gradient of risk, nor do known racial variations in environmental risk factors. Data on the incidence of and risk factors for VTE outside of Europe and North America and in non-European ancestry populations are sparse. Common genetic polymorphisms in European-Ancestry populations, such as factor V Leiden and prothrombin G20210A, and environmental risk factors, such as obesity, may account for some of the increased risk in European populations, and high factor VIII, high von Willebrand factor and low protein C levels and increased prevalence of obesity may explain some of the increased risk in African-Americans. The low rates in Asian populations may be partially explained by low clinical suspicion in a perceived low-risk population and lack of access to healthcare in other populations. As risk factors for thrombosis, such as surgery and treatment for cancer, are applicable to more people, as obesity increases in prevalence in the developing world, and as surveillance systems for VTE improve, VTE may increase in previously low-risk populations. While differences in VTE by race due to genetic predisposition will probably always be present, understanding the reasons for racial differences in VTE will help providers develop strategies to minimize VTE in all populations.
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Affiliation(s)
- N A Zakai
- Department of Medicine and Pathology, College of Medicine, University of Vermont, Colchester, VT 05446, USA.
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Zöller B, Li X, Ohlsson H, Sundquist J, Sundquist K. Venous thromboembolism does not share strong familial susceptibility with ischemic stroke: a nationwide family study in Sweden. ACTA ACUST UNITED AC 2011; 4:484-90. [PMID: 21880672 DOI: 10.1161/circgenetics.111.959882] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coagulation allelic variants associated with venous thromboembolism (VTE) have been suggested to be involved in the pathogenesis of ischemic stroke. This nationwide study aimed at determining whether VTE shares familial susceptibility with ischemic stroke. METHOD AND RESULTS The Swedish Multigeneration Register of 0- to 75-year-old subjects was linked to the Swedish Hospital Discharge Register and the Cause of Death Register for the period 1987 to 2007. Odds ratios (ORs) for VTE and ischemic stroke were determined in 2 ways: odds of ischemic stroke in offspring whose parents had been diagnosed with VTE, and odds of VTE in offspring whose parents had been diagnosed with ischemic stroke. The analyses were repeated for siblings and spouses. Offspring of parents with VTE (n=25,929) were at increased risk for ischemic stroke (n=5595): OR, 1.10 (95% confidence interval [CI], 1.06-1.14). Siblings of probands with VTE (n=45,132) had no increased risk of ischemic stroke (n=1716): OR, 1.05 (95% CI, 1.00-1.11). Spouses of probands with VTE (n=24,106) were at increased risk for ischemic stroke (n=940): OR, 1.18 (95% CI, 1.10-1.27). The risks for VTE in relatives of probands with ischemic stroke were OR, 1.15; 95% CI, 1.10-1.21 (offspring); OR, 1.07; 95% CI, 1.02-1.12 (siblings); and OR, 1.21; 95% CI, 1.11-1.32 (spouses). CONCLUSIONS VTE does not share strong familial susceptibility with ischemic stroke in the Swedish population. Moreover, familial nongenetic factors contribute to the observed weak familial associations. The present study suggests that it is unlikely that strong shared disease-causing mutations exist to a large extent in the Swedish population.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Region Skåne and Lund University, Malmö, Sweden.
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Familial risk factors shared by venous thromboembolism and cancer: A nationwide epidemiological study of Swedish families. Thromb Res 2011; 128:141-8. [DOI: 10.1016/j.thromres.2011.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/13/2011] [Accepted: 03/21/2011] [Indexed: 02/01/2023]
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Zöller B, Li X, Sundquist J, Sundquist K. Venous thromboembolism does not share strong familial susceptibility with coronary heart disease: a nationwide family study in Sweden. Eur Heart J 2011; 32:2800-5. [PMID: 21750095 DOI: 10.1093/eurheartj/ehr223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This nationwide study aimed to determine whether venous thromboembolism (VTE) shares familial susceptibility with coronary heart disease (CHD). METHODS AND RESULTS Data from the Swedish Multigeneration Register for subjects aged 0-76 years old for the period 1964-2008 were linked to the Hospital Discharge Register and Cause of Death Register. Familial risks of VTE and CHD were examined in two ways: risk of CHD in offspring whose parents had been diagnosed with VTE, and risk of VTE in offspring whose parents had been diagnosed with CHD. The analyses were repeated separately for siblings and spouses. In total, 174 768 offspring had CHD and 56 302 VTE. No association between VTE and CHD was observed among siblings. Among offspring, a lower risk of CHD was observed in subjects whose parents had suffered from VTE [standardized incidence ratio (SIR) 0.94 (95% confidence interval (CI) 0.92-0.95)], while offspring of parents with CHD had an increased risk of VTE [SIR 1.03 (95% CI 1.01-1.04)]. In spouses of VTE patients, an increased risk of CHD was observed [SIR 1.02 (95% CI 1.01-1.03)]. Conversely, risk of VTE was increased among spouses of CHD patients [SIR 1.03 (95% CI 1.02-1.03)]. Subanalyses of cases of myocardial infarction and pulmonary embolism/deep venous thrombosis showed similar results. CONCLUSION The familial background of CHD is different from that of VTE. The present study suggests that it is unlikely that shared disease-causing mutations exist to a large extent in the population.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Floor 11, Building 28, Entrance 72, Malmö University Hospital, S-205 02 Malmö, Sweden.
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