Thrombophilia Testing, Recurrent Thrombosis, and Women’s Health

Piazza, Gregory

doi:10.1161/circulationaha.113.007664

Cited by 16 publications

(12 citation statements)

References 24 publications

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“…9,38–40 The one exception may be the antiphospholipid antibody syndrome, which is associated with significant VTE recurrence risk (RR ~2) and has implications for treatment strategies. 41,42 However, several parameters of antiphospholipid antibody testing may be altered by VTE and anticoagulation. 43 The utility and yield of each test needs to be considered in each patient.…”

Section: Risk Assessment For Vte Recurrencementioning

confidence: 99%

Venous thromboembolism: Predicting recurrence and the need for extended anticoagulation

2015

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Initial treatment for venous thromboembolism (VTE) includes the acute and intermediate phases, usually lasting for 3 months. The choice to extend therapy beyond the initial 3-month window involves assessing a combination of risk factors for VTE recurrence and bleeding, along with weighing patient preferences. In some cases, such as VTE provoked by a reversible surgical risk factor, the recurrence risk is sufficiently low that most patients should not receive extended therapy. In other cases, such as VTE associated with malignancy, the recurrence risk is sufficiently high that treatment should be extended beyond the initial 3 months. However, a large number of patients fall into a grey zone where the decision on extended therapy is less clear-cut. In this review, we summarize the evidence for VTE recurrence risk and the role for extended anticoagulation given a variety of patient-specific factors and laboratory results. We also review the role of VTE risk prediction tools and provide a recommended algorithm for approaching the decision of extended anticoagulation therapy. Various agents available for extended VTE therapy, including warfarin, aspirin and the direct oral anticoagulant agents, are discussed.

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Section: Risk Assessment For Vte Recurrencementioning

confidence: 99%

Venous thromboembolism: Predicting recurrence and the need for extended anticoagulation

2015

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“…Previous studies have used tools to predict the risk of VTE recurrence, which incorporate factors such as the presence of residual VTE, the location of the VTE, age and sex, as well as various laboratory and imaging tests . Besides, antiphospholipid antibody syndrome, factor V Leiden mutation, deficiencies of protein C, protein S and antithrombin and elevated homocysteine levels have been associated with significant VTE recurrence. Given the above discussed risks, patients with unprovoked VTE should receive ‘lifelong’ anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of low‐intensity warfarin therapy in preventing unprovoked recurrent venous thromboembolism: A systematic review and meta‐analysis

Jiang

Shi

Zhang

et al. 2018

Clinical Respiratory J

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Background: Although there exists potential risk of bleeding, extended 'lifelong' conventional-intensity [international normalized ratio (INR): 2.0-3.0] warfarin anticoagulation is recommended for unprovoked venous thromboembolism (VTE) patients because of risk of recurrent VTE. Whether long-term low-intensity (INR: 1.5-2.0) warfarin therapy reduced the risk of major bleeding without substantially lowered antithrombotic efficacy is not well understood. The aim of this study was to perform a systematic review and meta-analysis to evaluate the risk-benefits of low-intensity warfarin therapy.

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“…Heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation and resistance to activated protein C (a natural anticoagulant) may have created, in this particular patient with nonvalvular AF, resistance to warfarin therapy. Factor V Leiden mutation induces the resistance of factor V to cleavage by activated protein C [10]. The enzyme 5,10-methylenetetrahydrofolate reductase is involved in folate metabolism and its C677T polymorphism is associated with increased plasma homocysteine levels if the dietary folate intake is insufficient [11].…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report

Scarano¹,

Casale

Mantini

et al. 2017

J Med Case Reports

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BackgroundAtrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention.Case presentationWe present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C. Anticoagulant therapy was switched to heparin for 1 week and then to rivaroxaban. After 3 months of rivaroxaban use, the thrombus disappeared.ConclusionsThis case raises the issue of the ineffectiveness of warfarin therapy in complex cases involving particular thrombophilic conditions and the possibility of using rivaroxaban as a safe and effective alternative.

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Thrombophilia Testing, Recurrent Thrombosis, and Women’s Health

Cited by 16 publications

References 24 publications

Venous thromboembolism: Predicting recurrence and the need for extended anticoagulation

Venous thromboembolism: Predicting recurrence and the need for extended anticoagulation

Comparative efficacy and safety of low‐intensity warfarin therapy in preventing unprovoked recurrent venous thromboembolism: A systematic review and meta‐analysis

Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report

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