Risk of Recurrent Venous Thromboembolism in Patients With Common Thrombophilia

Ho, Wai Khoon; Hankey, Graeme J.; Quinlan, Daniel J.; Eikelboom, John W.

doi:10.1001/archinte.166.7.729

Cited by 285 publications

(203 citation statements)

References 46 publications

Supporting

Mentioning

192

Contrasting

Unclassified

Order By: Relevance

“…Meta-analyses were in favor of a potential role, at least of factor V Leiden. Ho et al presented the most updated view on this topic in an exhaustive meta-analysis of all available studies [34]. Pooled results from 10 studies involving 3104 patients with the first VTE revealed that the presence of heterozygous factor V Leiden is associated with increased odds of recurrent VTE.…”

Section: Screening For Thrombophilia and Recurrent Thromboembolismmentioning

confidence: 99%

Thrombophilia – How Far and How Much to Investigate?

et al. 2012

View full text Add to dashboard Cite

Thrombohemorrhagic balance is maintained by complicated interactions between the coagulation and fibrinolytic system, platelets, and the vessel wall. Dr. Virchow provided approach for investigating and managing thrombotic disorders. He proposed stasis, vascular injury, and hypercoagulability as causes for thrombosis. In 1965, antithrombin deficiency was described. After two decades, protein C and protein S deficiencies, mutations of factor V Leiden, and factor II were described. If we distinguish patients at high risk and low risk of thrombosis, we can optimize therapeutic decisions. There is currently no evidence to say that laboratory abnormality should influence intensity of anticoagulation. In this article we reviewed the risk factors and need for thrombophilia screening in patients. Screening general population for thrombophilia is not justified or recommended at this time.

show abstract

Section: Screening For Thrombophilia and Recurrent Thromboembolismmentioning

confidence: 99%

Thrombophilia – How Far and How Much to Investigate?

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The fact that she is heterozygous for the factor V Leiden mutation may slightly increases her risk of recurrence. 26 Whether the pelvic stents increase the risk of recurrence is not known. The patient and her physician decide to stop her anticoagulation, as (1) they consider her risk of recurrence to be relatively low, (2) she is well aware of the symptoms of DVT and PE and knows to seek early medical attention if such symptoms occur, (3) she knows to avoid estrogen-containing contraceptives, (4) she will avoid dehydration, (5) she is aware that she needs diligent VTE prophylaxis if she has major surgery, immobility, or trauma, and (6) she will consider taking an injection of low-dose low molecular weight heparin before long flights, such as flights of more than 5 h duration.…”

Section: Length Of Warfarin Therapymentioning

confidence: 99%

The History of the Present Illness

Schildkrout¹

2011

Unmasking Psychological Symptoms

View full text Add to dashboard Cite

“…A pooled analysis of the literature found the risk associated with factor V Leiden mutation to be significantly increased, but the magnitude was so modest that this by itself does not merit committing a patient to long-term anticoagulation (odds ratios of approximately 1.5 each for factor V Leiden and prothrombin G20210A). 15,16 Hereditary deficiencies of antithrombin, protein C, or protein S are much less frequently encountered in clinical practice, and one of these disorders will be identified in fewer than 5% of patients presenting with a first unprovoked episode of VTE; this is increased up to about 15% if the patient is under age 50 and has a positive family history. Patients with these less common thrombophilic defects may merit long-term anticoagulation, particularly if other first-degree family members have sustained VTE.…”

Section: Clinical Vignette: a 61-year-old Male In Excellent Health Sumentioning

confidence: 99%

Duration of Anticoagulation: Applying the Guidelines and Beyond

Bauer

2010

Hematology

View full text Add to dashboard Cite

Despite an improved understanding of the risk factors underlying venous thromboembolism (VTE), extensive clinical investigation, and detailed clinical guidelines, the decision to extend anticoagulation indefinitely for an individual patient with VTE is often problematic. Patients with VTE in association with major surgery, trauma, immobilization, or pregnancy are at relatively low risk of recurrence and generally do not require more than 3 to 6 months of anticoagulant therapy. For patients with a first unprovoked, or idiopathic, episode of VTE, an individualized approach should be taken in deciding on the duration of anticoagulation based on the patient's recurrence and bleeding risk, as well as their personal preference. Although the presence of genetic thrombophilic disorders (factor V Leiden and prothrombin G20210A gene mutations; deficiencies of antithrombin, protein C, and protein S) predispose patients to a first episode of VTE, there is inconsistent data on whether testing for these defects changes patient outcomes or should alter their management. In patients with a single unprovoked VTE, measurement of D-dimer several weeks following the completion of anticoagulant therapy appears useful in stratifying patients with a first unprovoked episode of VTE with regard to recurrence risk. Through a series of clinical vignettes, the utility of the laboratory in risk-stratifying patients with respect to recurrence risk will be discussed, along with decision making regarding the duration of anticoagulation. The potential impact of having a nonremovable inferior vena caval filter will also be addressed.

show abstract

Risk of Recurrent Venous Thromboembolism in Patients With Common Thrombophilia

Cited by 285 publications

References 46 publications

Thrombophilia – How Far and How Much to Investigate?

Thrombophilia – How Far and How Much to Investigate?

The History of the Present Illness

Duration of Anticoagulation: Applying the Guidelines and Beyond

Contact Info

Product

Resources

About