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Wang Z, Wu H. The Association of Prothrombin Gene G20210A Mutation with Recurrent Venous Thromboembolism: Evidence from a Meta-Analysis. Ann Vasc Surg 2024:S0890-5096(24)00484-9. [PMID: 39096951 DOI: 10.1016/j.avsg.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES The prothrombin (PT) G20210A mutation is one of the most prevalent genetic variations associated with an increased susceptibility to the first episode of venous thromboembolism (VTE). However, it remains uncertain whether this inherited thrombophilic abnormality also poses a risk for recurrent VTE. This meta-analysis aimed to assess the relation of PT G20210A mutation to the risk of recurrent VTE. METHODS PubMed and Scopus were systematically searched for pertinent prospective studies. Relative risks (RR) and 95% confidence intervals (CI) were used to test the association. Sixteen studies, with 16,174 participants, were included. RESULTS Carriers of the G20210 A mutation were at increased risk of recurrent VTE (RR = 1.60, 95% CI = 1.20-2.14) compared to noncarriers; the increased risk was observed in heterozygotes (GA versus GG) (RR = 1.79, 95% CI = 1.24-2.57), but not in GA/AA mutation. CONCLUSIONS This association was found to be significant in the long term (≥5 years of follow-up), but not in the short term (<5 years of follow-up).
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Affiliation(s)
- Zaiqing Wang
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
| | - Han Wu
- Department of General Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China.
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2
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Garland K, Mullins E, Bercovitz RS, Rodriguez V, Connors J, Sokkary N. Hemostatic considerations for gender affirming care. Thromb Res 2023; 230:126-132. [PMID: 37717369 DOI: 10.1016/j.thromres.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
Gender dysphoria or gender incongruence is defined as "persons that are not satisfied with their designated gender" [1]. The awareness and evidence-based treatment options available to this population have grown immensely over the last two decades. Protocols now include an Endocrine Society Clinical Practice Guideline [1] as well as the World Professional Association of Transgender Health Standards of Care (WPATH SOC) [2]. Hematologic manifestations, most notably thrombosis, are one of the most recognized adverse reactions to the hormones used for gender-affirming care. Therefore, hematologists are frequently consulted prior to initiation of hormonal therapy to help guide safe treatment. This review will focus on the scientific evidence related to hemostatic considerations for various gender-affirming therapies and serve as a resource to assist in medical decision-making among providers and patients.
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Affiliation(s)
- Kathleen Garland
- Children's Minnesota, Minneapolis, MN 55404, United States of America.
| | - Eric Mullins
- Cincinnati Children's Hospital Medical Center and University of Cincinnati-College of Medicine, Cincinnati, OH 45229, United States of America
| | - Rachel S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America
| | - Vilmarie Rodriguez
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205, United States of America
| | - Jean Connors
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, United States of America
| | - Nancy Sokkary
- Children's Healthcare of Atlanta, Atlanta, GA 30308, United States of America
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3
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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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4
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Florin J, Stalder O, Baumgartner C, Méan M, Rodondi N, Aujesky D. Do Patients with a Family or Personal History of Venous Thromboembolism have an Increased Risk of Recurrence? Thromb Haemost 2021; 122:1017-1026. [PMID: 34963186 DOI: 10.1055/s-0041-1740184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND A family (FH) and personal history (PH) of venous thromboembolism (VTE) are commonly evaluated risk factors for recurrence. We examined the association between FH/PH of VTE and the risk of recurrence and whether a stronger history status (i.e., both FH/PH vs. no FH/PH) carries an increased recurrence risk. METHODS We prospectively followed 813 patients aged ≥ 65 years with acute VTE from 9 Swiss hospitals. We classified patients into four groups: no FH/PH, FH only, PH only, and both FH/PH. The primary outcome was recurrent VTE during the full observation period. We examined the association between FH/PH status and the time to VTE recurrence using competing risk regression, adjusting for confounders and periods of anticoagulation. RESULTS Of 813 patients with VTE, 59% had no FH/PH, 11% a FH only, 24% a PH only, and 7% had both a FH and PH of VTE. Overall, 105 patients had recurrent VTE during the full observation period. After adjustment, patients with a FH only (subhazard ratio [SHR] 0.8, 95% confidence interval [CI] 0.4-1.7), PH only (SHR 1.5, 95% CI 0.9-2.5), and both FH/PH (SHR 1.4, 95% CI 0.6-3.1) did not have an increased risk of recurrent VTE compared with those without FH/PH. When we considered the period after the completion of initial anticoagulation only, the results were similar. CONCLUSION Our findings indicate that in patients with acute VTE, a FH and/or PH of VTE does not convey an increased risk of recurrent VTE. In particular, we did not find a "dose-effect" relationship between FH/PH status and VTE recurrence.
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Affiliation(s)
- Jonas Florin
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
| | | | - Christine Baumgartner
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
| | - Marie Méan
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland
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5
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Assaf N, Chamseddine F, Taher A, Mahfouz R. Prevalence of thrombophilia-associated mutations and their clinical significance in a large cohort of Lebanese patients. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Fibrinolysis is of paramount importance in maintaining or regaining the patency of veins and pulmonary arteries obstructed by thrombi. Growing experimental and clinical evidence indicates that impaired fibrinolysis mediated by multiple complex mechanisms is involved in venous thromboembolism (VTE). Global plasma fibrin clot lysis markers, especially clot lysis time, have been reported to predict recurrent deep-vein thrombosis and pulmonary embolism. The current overview summarizes available data linking fibrinolysis to VTE and its long-term sequelae.
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Affiliation(s)
- Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Krakow Centre for Medical Research and Technologies, John Paul II Hospital, Krakow, Poland
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7
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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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de Moreuil C, Le Mao R, Le Moigne E, Pan-Petesch B, Tromeur C, Hoffmann C, Salaun PY, Nonent M, Danguy des Déserts M, Savary X, Guegan M, Poulhazan E, Leroyer C, Lacut K, Couturaud F. Long-term recurrence risk after a first venous thromboembolism in men and women under 50 years old: A French prospective cohort. Eur J Intern Med 2021; 84:24-31. [PMID: 33214024 DOI: 10.1016/j.ejim.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Data on long-term venous thromboembolism (VTE) recurrence risk according to gender are conflicting. OBJECTIVE To evaluate long-term VTE recurrence risk after a first VTE in men and women under 50 years old. METHODS Since May 2000, 875 consecutive patients (315 men, 560 women) with a first symptomatic VTE under 50 years old were enrolled in a French prospective multicentre cohort study and were followed up as long as possible. The primary outcome was symptomatic recurrent VTE during follow-up. RESULTS At baseline, men were older and had more comorbidities than women. First VTE was mainly unprovoked in men (80.6%) and hormone-related in women (84.3%). During a median follow-up of 7.0 years (inter-quartile range, 5.0-11.0), recurrent VTE occurred in 97 men (30.8%) and in 72 women (12.9%) (annual incidence rates of recurrent VTE of 4.8% versus 1.8%-person-years, P<0.001). However, there was no difference according to gender in subgroups of patients with a first unprovoked VTE (5.8% versus 3.8%-person-years, P = 0.09). In women, duration of hormonal treatment before first VTE did not influence recurrence risk. In multivariable analysis, unprovoked VTE and family history of VTE were independently associated with recurrence (hazard ratio of 2.50 (95% confidence interval, 1.61 to 3.85) and 1.52 (1.11 to 2.09) respectively). LIMITATIONS Number of women with unprovoked VTE was low. CONCLUSIONS In patients with a first VTE under 50 years old, a first unprovoked episode and a family history of VTE, but not gender, were associated with a high risk of long-term recurrence.
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Affiliation(s)
- Claire de Moreuil
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Raphael Le Mao
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | - Emmanuelle Le Moigne
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Brigitte Pan-Petesch
- EA3878, GETBO, Univ Brest, Brest, France; Service d'hématologie, CHU Brest, Univ Brest, Brest, France
| | - Cécile Tromeur
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Clément Hoffmann
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Pierre-Yves Salaun
- EA3878, GETBO, Univ Brest, Brest, France; Service de médecine nucléaire, CHU Brest, Univ Brest, Brest, France
| | - Michel Nonent
- EA3878, GETBO, Univ Brest, Brest, France; Service de radiologie, CHU Brest, Univ Brest, Brest, France
| | - Marc Danguy des Déserts
- EA3878, GETBO, Univ Brest, Brest, France; Service d'anesthésie réanimation, HIA, Brest, France
| | - Xavier Savary
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France
| | - Marie Guegan
- EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | | | - Christophe Leroyer
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
| | - Karine Lacut
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France.
| | - Francis Couturaud
- Département de médecine vasculaire, médecine interne et pneumologie, CHU Brest, Univ Brest, Brest, France; EA3878, GETBO, Univ Brest, Brest, France; CIC INSERM1412, CHU Brest, Univ Brest, Brest, France
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9
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Couturaud F, Girard P, Laporte S, Sanchez O. [What duration of anticoagulant treatment for PE/proximal DVT?]. Rev Mal Respir 2019; 38 Suppl 1:e99-e112. [PMID: 31711819 DOI: 10.1016/j.rmr.2019.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- F Couturaud
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; EA3878-GETBO, CIC Inserm1412, département de médecine interne et pneumologie, centre hospitalo-universitaire de Brest, université de Bretagne occidentale, 29200 Brest, France
| | - P Girard
- Institut du thorax-Curie-Montsouris, l'institut mutualiste Montsouris, 75014 Paris, France
| | - S Laporte
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; SAINBOIS U1059 équipe DVH, Unité de recherche clinique, Inserm, innovation, pharmacologie, CHU de Saint-Étienne, université Jean-Monnet, université de Lyon, hôpital du Nord, 42000 Saint-Étienne, France
| | - O Sanchez
- F-CRIN INNOVTE, 42055 Saint-Étienne cedex 2, France; Service de pneumologie et soins intensifs, université de Paris, AH-HP, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Innovations thérapeutiques en hémostase, Inserm UMRS 1140, 75006 Paris, France.
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10
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Wang X, Sundquist K, Svensson PJ, Rastkhani H, Palmér K, Memon AA, Sundquist J, Zöller B. Association of recurrent venous thromboembolism and circulating microRNAs. Clin Epigenetics 2019; 11:28. [PMID: 30760335 PMCID: PMC6374897 DOI: 10.1186/s13148-019-0627-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with unprovoked first venous thromboembolism (VTE) are at a high risk of recurrence. Although circulating microRNAs (miRNAs) have been found to be associated with VTE and are markers of hypercoagulability, this study is the first to examine whether circulating miRNAs are associated with the risk of VTE recurrence. RESULTS A nested case-control study design was used where plasma samples were obtained from 78 patients with unprovoked VTE from the Malmö Thrombophilia Study (MATS). A total of 39 VTE patients with recurrent VTE (cases) were matched with 39 VTE patients without recurrent VTE (controls) defined by age and sex (MATS population). Plasma levels of 179 different miRNAs were evaluated in the 78 samples (after anticoagulant treatment was stopped) using qPCR. A total of 110 miRNAs were detected in all samples. Among those, 12 miRNAs (miR-15b-5p, miR-106a-5p, miR-197-3p, miR-652-3p, miR-361-5p, miR-222-3p, miR-26b-5p, miR-532-5p, miR-27b-3p, miR-21-5p, miR-103a-3p, and miR-30c-5p) were found to be associated with recurrent VTE after multiple correction test and conditional logistic regression analysis. A further analysis showed that miR-15b-5p, miR-197-3p, miR-27b-3p, and miR-30c-5p exhibited a trend over time, with a larger difference in miRNA levels between cases and controls for earlier recurrence. Of these 12 miRNAs, 8 miRNAs significantly correlated with circulating transforming growth factor β1/2 (TGFβ1/2). Three of them correlated with platelet count. CONCLUSION We have identified 12 plasma miRNAs that may have the potential to serve as novel, non-invasive predictive biomarkers for VTE recurrence.
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Affiliation(s)
- Xiao Wang
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Peter J Svensson
- Department of Coagulation Disorders, Lund University, Malmö, University Hospital, Malmö, Sweden
| | - Hamideh Rastkhani
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden
| | - Karolina Palmér
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Bengt Zöller
- Center for Primary Health Care Research, Wallenberglaboratoriet, Lund University/Region Skåne, Inga-Marie Nilssons gata 53, plan 6, Box 50332, 202 13, Malmö, Sweden
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Ahmad A, Sundquist K, Palmér K, Svensson PJ, Sundquist J, Memon AA. Risk prediction of recurrent venous thromboembolism: a multiple genetic risk model. J Thromb Thrombolysis 2019; 47:216-226. [PMID: 30368761 PMCID: PMC6394443 DOI: 10.1007/s11239-018-1762-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A single genetic biomarker is unable to accurately predict the risk for venous thromboembolism (VTE) recurrence. We aimed to: (a) develop a multiple single nucleotide polymorphisms (SNPs) model to predict the risk of VTE recurrence and (b) validate a previously described genetic risk score (GRS) and compare its performance with the model developed in this study. Twenty-two SNPs, including established and putative SNPs associated with VTE risk, were genotyped in the Malmö thrombophilia study cohort (MATS; n = 1465, follow-up ~ 10 years) by using TaqMan PCR. Out of 22-SNPs, 12 had an association with the risk of VTE recurrence and were included for calculating GRSs. The risk of VTE recurrence was calculated by stratifying patients according to number of risk alleles. In 12-SNP GRS, patients with ≥ 7 risk alleles were associated with higher risk of VTE recurrence compared to patients having ≤ 6 risk alleles. In a simplified model (8-SNP GRS), the discriminative power of 8-SNP GRS was similar to that of 12-SNP GRS based on post-test probabilities (PP). Furthermore, 8-SNP GRS further improved the risk prediction of VTE recurrence in unprovoked VTE and male patients (PP% = 15.4 vs 8.3, 17.1 vs 7.2 and 19.0 vs 7.1 for high risk groups vs low risk groups in whole population, males and unprovoked VTE patients respectively). In addition, we also validated previously described 5-SNP GRS in our cohort and found that the 8-SNP GRS performed better than the 5-SNP GRS in terms of higher PP. Our results show that a multiple SNP GRS consisting of 8-SNPs may be an effective model for prediction of VTE recurrence, particularly in unprovoked VTE and male patients.
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Affiliation(s)
- Abrar Ahmad
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
- Wallenberg Laboratory, 6th Floor, Inga Marie Nilssons Gata 53, 20502, Malmö, Sweden.
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Karolina Palmér
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter J Svensson
- Department of Coagulation Disorders, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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12
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Ahmad A, Sundquist K, Svensson PJ, Sundquist J, Zöller B, Memon AA. Alpha 2-macroglobulin 5 bp insertion/deletion polymorphism increases the risk of recurrent venous thromboembolism. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Altered plasma clot properties increase the risk of recurrent deep vein thrombosis: a cohort study. Blood 2017; 131:797-807. [PMID: 29242187 DOI: 10.1182/blood-2017-07-798306] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022] Open
Abstract
It has been demonstrated that fibrin clots generated from plasma samples obtained from patients with prior thromboembolic events are denser and less susceptible to lysis. Such a prothrombotic fibrin clot phenotype has been suggested as a new risk factor for venous thromboembolism, but its prognostic value is unclear. To assess whether abnormal clot properties can predict recurrent deep vein thrombosis (DVT), we studied 320 consecutive patients aged 18 to 70 years following the first-ever DVT. Plasma clot properties were evaluated after 3 months of anticoagulant treatment since the index event. A mean duration of anticoagulation was 10 months (range, 4-20). Recurrent DVT was observed in 77 patients (25%; 6.6%/year) during a median follow-up of 44 months. Recurrences of DVT were associated with faster formation (-9% lag phase) of denser fibrin networks (-12% fibrin clot permeability [Ks]) and 4% higher maximum absorbance of plasma clots that displayed impaired fibrinolytic degradation (+25% prolonged clot lysis time [CLT]) and a 5% slower rate of increase in D-dimer levels during clot degradation (D-Drate; all P < .05). Proximal DVT alone, higher C-reactive protein, D-dimer, peak thrombin, lower Ks, shorter lag phase, decreased D-Drate, and prolonged CLT were independent predictors of recurrences (all P < .05). Individuals characterized by low Ks (≤7.3 × 10-9 cm2) and prolonged CLT (>96 min) were at the highest risk of recurrent DVT (odds ratio, 15.8; 95% confidence interval, 7.5-33.5). Kaplan-Meier curves showed that reduced Ks and prolonged CLT predicted recurrent DVT. We demonstrate that unfavorably altered clot properties may predict recurrent DVT after anticoagulation withdrawal.
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Obesity is not associated with recurrent venous thromboembolism in elderly patients: Results from the prospective SWITCO65+ cohort study. PLoS One 2017; 12:e0184868. [PMID: 28915260 PMCID: PMC5600372 DOI: 10.1371/journal.pone.0184868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/03/2017] [Indexed: 11/26/2022] Open
Abstract
Background Whether obesity is associated with recurrent venous thromboembolism (VTE) in elderly patients is unknown. Objectives To examine the association between two obesity measures, the body mass index (BMI) and the waist circumference (WC), and recurrent VTE in elderly patients. Patients/Methods We studied 986 patients aged ≥65 years with an acute VTE from a prospective multicenter cohort study (09/2009-12/2013). The BMI was determined and categorized as <25, 25 to <30, or ≥30 kg/m2. The WC was categorized as <80 cm in women (w)/<94 cm in men (m), 80 to <88 cm (w)/94 to <102 cm (m), or ≥88 cm (w)/≥102 cm (m). We examined the association between the BMI and the WC and the time to a first symptomatic recurrent VTE using competing risk regression, adjusting for known risk factors of VTE recurrence and periods of anticoagulation. Results The mean follow-up was 28 months. The 3-year cumulative incidence of recurrent VTE did not vary by BMI and was 17.6% for a BMI <25 kg/m2, 11.5% for a BMI 25 to <30 kg/m2, and 16.9% for a BMI ≥30 kg/m2 (P = 0.09). The 3-year cumulative incidence of recurrent VTE did not vary by WC. After adjustment, neither the BMI (sub-hazard ratio [SHR] 1.02, 95% confidence interval [CI 0.98–1.05]) nor the WC (SHR 1.01, 95% CI 0.99–1.02) was associated with recurrent VTE. Conclusions Measures of body weight were not associated with recurrent VTE in our cohort. Obesity does not appear to be a predictor of recurrent VTE in the elderly.
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Lehman LL, Beaute J, Kapur K, Danehy AR, Bernson-Leung ME, Malkin H, Rivkin MJ, Trenor CC. Workup for Perinatal Stroke Does Not Predict Recurrence. Stroke 2017; 48:2078-2083. [DOI: 10.1161/strokeaha.117.017356] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/09/2017] [Accepted: 06/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Laura L. Lehman
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Jeanette Beaute
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Kush Kapur
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Amy R. Danehy
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Miya E. Bernson-Leung
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Hayley Malkin
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Michael J. Rivkin
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
| | - Cameron C. Trenor
- From the Stroke and Cerebrovascular Center (L.L.L., J.B., A.R.D., M.E.B.-L., H.M., M.J.R., C.C.T.), Departments of Neurology (L.L.L., J.B., K.K., M.E.B.-L., M.J.R.), Psychiatry (M.J.R.), and Radiology (A.R.D., M.J.R.), and Division of Hematology/Oncology (H.M., C.C.T.), Boston Children’s Hospital, Harvard Medical School, MA
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Zöller B, Pirouzifard M, Sundquist J, Sundquist K. Family history of venous thromboembolism and mortality after venous thromboembolism: a Swedish population-based cohort study. J Thromb Thrombolysis 2017; 43:469-475. [PMID: 27990607 PMCID: PMC5375967 DOI: 10.1007/s11239-016-1464-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Studies on whether family history (FH) of venous thromboembolism (VTE) affects long-term mortality after VTE are missing. The aim of this study was to determine whether FH of VTE affects long-term mortality after a first episode of VTE. Using Swedish medical databases, we conducted a 30-year nationwide cohort study of 49,159 adult Swedish born patients included in the multi-generation register (born 1932 or later) with a first-time VTE (1981–2010). Using Cox regression, we assessed mortality Hazard ratios (HRs) with 95% confidence intervals (CIs). Totally 10,093 (20.5%) patients with VTE had a first-degree FH of VTE (parent/sibling). Patients without FH of VTE had significantly more VTE provoking risk factors and comorbidities than those with FH. The mortality HR the first 10-years after first time VTE was decreased for those with FH of VTE compared to for those without FH: crude HR 0.807, 95% CI 0.771–0.845 and adjusted HR 0.864, 95% CI 0.826–0.905. After 10-years of follow-up there was no significant effect of FH of VTE on mortality: crude HR = 1.018, 95% CI 0.905–1.145 and adjusted HR = 0.995, 95% CI 0.884–1.119. Cancer-associated mortality was more common in those without FH the first 10 years (56.9 vs. 53.4%, p = 0.002). After 10 years there were no difference in cancer-associated mortality (4.9 vs. 5.6%, p = 0.604). The results suggest that patients with FH of VTE have lower thrombotic threshold and need less provoking factors and comorbidities. They have also slightly lower total and cancer mortality the first 10 years after VTE.
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Affiliation(s)
- Bengt Zöller
- Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden.
| | - Mirnabi Pirouzifard
- Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Skåne University Hospital, Lund University/Region Skåne, CRC, Building 28, Floor 11, Entrance 72, 205 02, Malmö, Sweden
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A sibling based design to quantify genetic and shared environmental effects of venous thromboembolism in Sweden. Thromb Res 2017; 149:82-87. [DOI: 10.1016/j.thromres.2016.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/09/2016] [Accepted: 10/14/2016] [Indexed: 11/22/2022]
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Ahmad A, Sundquist K, Zöller B, Dahlbäck B, Svensson PJ, Sundquist J, Memon AA. Identification of polymorphisms in Apolipoprotein M gene and their relationship with risk of recurrent venous thromboembolism. Thromb Haemost 2016; 116:432-41. [PMID: 27277397 DOI: 10.1160/th16-03-0178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/06/2016] [Indexed: 11/05/2022]
Abstract
Apolipoprotein M (ApoM) plasma levels have been reported to be associated with risk of venous thromboembolism (VTE) recurrence. However, the role of genetic alterations in the ApoM gene in VTE recurrence remains unknown. The aim of this study was to identify genetic aberrations in ApoM gene in VTE recurrence and their role in prediction of VTE recurrence in a prospective follow-up study of 1465 VTE patients. During follow-up, 156 (10.6 %) patients had VTE recurrence. First screening of whole ApoM gene was performed by Sanger's sequencing in selected age and sex matched non-recurrent and recurrent patients (n=95). In total six polymorphisms were identified and two polymorphisms (rs805297 and rs9404941) with minor allele frequency (MAF) ≥5 % were further genotyped in the whole cohort by Taqman PCR. ApoM rs805297 polymorphism was significantly associated with higher risk of VTE recurrence in males but not in females on both univariate (p= 0.038, hazard ratio = 1.72, confidence interval = 1.03-2.88) and on multivariate analysis adjusted with mild and severe thrombophilia, family history, location and acquired risk factors for VTE. However, ApoM rs9404941 polymorphism showed no significant association with risk of VTE recurrence in all patients as well as in different gender groups. Moreover, ApoM rs805297 and rs9404941 polymorphisms were not associated with the ApoM plasma levels. In conclusion, for the first time we have sequenced whole ApoM gene in VTE and identified six polymorphisms. ApoM rs805297 was significantly associated with higher risk of VTE recurrence in male but not in female patients.
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Affiliation(s)
- Abrar Ahmad
- Abrar Ahmad, Wallenberg Laboratory, 6th floor, Inga Marie Nilsson's gata 53, S-20502 Malmö, Sweden, E-mail:
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