Efficiency of Systematic Thrombophilia Screening in Idiopathic Venous Thrombosis: A Prospective Study in Internal Medicine

Abstract

In case of unprovoked venous thromboembolism (VTE), the screening of thrombophilia is recommended whatever the age of the patient and the type of risk factors (RF). This prospective study was conducted in patients with unprovoked VTE to detect some predictive factors to have a higher risk of thrombophilia, focusing on age, history of venous thromboembolism, and the existence of a triggering event. From July 2000 to July 2002, in an Internal Medicine Department, unrelated patients with unprovoked VTE were included. Those unprovoked thromboembolic events were defined by the absence of association between permanent and transient RF. The primary outcome measure was the positivity of the thrombophilia screening for any type of abnormality detected (deficit of protein C, S, antithrombin, presence of a lupus anticoagulant, research of V and II mutations). Seventy-four patients were included. Eight died during the follow-up. A higher risk of thrombophilia was found in patients younger than 40 (p=0.03), or with a family but not personal history of VTE (p=0.01) or with transient RF (p=0.02). The most frequent abnormality of coagulation found in patients younger than 40 was the presence of a lupus anticoagulant. As a new strategy for the screening of thrombophilia, one could propose the following attitude: only patients with transient RF or family history of VTE could undergo a complete screening; for all the remaining patients who are younger than 40, a research of a lupus anticoagulant would be only performed. This strategy should now be balanced against the currently recommended systematic attitude in further studies.

Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry

“…These authors discovered a higher frequency of thrombophilia among patients younger than 40 years old when compared with older patients (64% vs. 32%; P = 0·03). However, after exclusion of patients with lupus anticoagulant ( N = 5), the frequency of thrombophilia did not differ between the two age groups (Pottier et al , ). In the Spanish Multicentric Study on Thrombophilia (EMET), which included 2132 VTE patients, a higher frequency of inhibitor deficiencies (AT, PC or PS) in VTE patients younger than 45 years was observed when compared with patients older than 45 years [17·9% vs. 10·7%; OR 1·8 (1·4–2·4)] (Mateo et al , ).…”

“…The authors discovered no difference in the prevalence of thrombophilia when comparing patients older and younger than 50 years of age. Pottier et al () investigated the presence of thrombophilia (i.e., APL; deficiencies of AT, PC or PS; F5 R506Q or F2 G20210A mutations) and common VTE risk factors in a cohort of 66 patients with unprovoked VTE. These authors discovered a higher frequency of thrombophilia among patients younger than 40 years old when compared with older patients (64% vs. 32%; P = 0·03).…”

Diagnosis and treatment strategies of thrombophilic risk factors

“…The individuals, who had a previous spontaneous VTE attacks or recurrent thrombotic attacks before age 50 and who had a family history of thrombosis at close relatives, are suggested to be evaluated for PC, PS and AT deficiency, APC-R, PTG mutation, APA and plasma homocysteine levels 19,20 .…”