Thrombophilia secondary prevention: Difference between revisions

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__NOTOC__
__NOTOC__
{{Thrombophilia}}
{{Thrombophilia}}
{{CMG}}; {{AE}} {{asiri}}
{{CMG}}; {{AE}} {{asiri}} {{JK}}


==Overview==
==Overview==
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**Recurrences are less common after 6–12 months of discontinuation of anticoagulant therapy and when the initial event is associated with a transient risk factor such as surgery, trauma, etc.
**Recurrences are less common after 6–12 months of discontinuation of anticoagulant therapy and when the initial event is associated with a transient risk factor such as surgery, trauma, etc.


Thromboprophylaxis with [[anticoagulation]] may be recommended for secondary prevention of acute thrombosis in high risk acquired and inherited thrombophilias:<ref name="pmid26780738">{{cite journal| author=Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R et al.| title=Guidance for the treatment of deep vein thrombosis and pulmonary embolism. | journal=J Thromb Thrombolysis | year= 2016 | volume= 41 | issue= 1 | pages= 32-67 | pmid=26780738 | doi=10.1007/s11239-015-1317-0 | pmc=4715858 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26780738  }} </ref><ref name=?>DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.</ref><ref name="pmid24421360">{{cite journal| author=Cohoon KP, Heit JA| title=Inherited and secondary thrombophilia. | journal=Circulation | year= 2014 | volume= 129 | issue= 2 | pages= 254-7 | pmid=24421360 | doi=10.1161/CIRCULATIONAHA.113.001943 | pmc=3979345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24421360  }} </ref><ref name="pmid11309638">{{cite journal| author=Seligsohn U, Lubetsky A| title=Genetic susceptibility to venous thrombosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 16 | pages= 1222-31 | pmid=11309638 | doi=10.1056/NEJM200104193441607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11309638  }} </ref><ref name="pmid22315265">{{cite journal| author=Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al.| title=Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e278S-325S | pmid=22315265 | doi=10.1378/chest.11-2404 | pmc=3278063 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315265  }} </ref><ref name="pmid11919306">{{cite journal| author=Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A et al.| title=Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 13 | pages= 975-80 | pmid=11919306 | doi=10.1056/NEJMoa012385 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11919306  }} </ref><ref name="pmid15598646">{{cite journal| author=Agnelli G| title=Prevention of venous thromboembolism in surgical patients. | journal=Circulation | year= 2004 | volume= 110 | issue= 24 Suppl 1 | pages= IV4-12 | pmid=15598646 | doi=10.1161/01.CIR.0000150639.98514.6c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15598646  }} </ref>  
{| class="wikitable"
|'''Table 1: Enlist the indications for the secondary prevention'''<ref name="pmid26780738">{{cite journal| author=Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R et al.| title=Guidance for the treatment of deep vein thrombosis and pulmonary embolism. | journal=J Thromb Thrombolysis | year= 2016 | volume= 41 | issue= 1 | pages= 32-67 | pmid=26780738 | doi=10.1007/s11239-015-1317-0 | pmc=4715858 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26780738  }} </ref><ref name=?>DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.</ref><ref name="pmid24421360">{{cite journal| author=Cohoon KP, Heit JA| title=Inherited and secondary thrombophilia. | journal=Circulation | year= 2014 | volume= 129 | issue= 2 | pages= 254-7 | pmid=24421360 | doi=10.1161/CIRCULATIONAHA.113.001943 | pmc=3979345 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24421360  }} </ref><ref name="pmid11309638">{{cite journal| author=Seligsohn U, Lubetsky A| title=Genetic susceptibility to venous thrombosis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 16 | pages= 1222-31 | pmid=11309638 | doi=10.1056/NEJM200104193441607 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11309638  }} </ref><ref name="pmid22315265">{{cite journal| author=Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al.| title=Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e278S-325S | pmid=22315265 | doi=10.1378/chest.11-2404 | pmc=3278063 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315265  }} </ref><ref name="pmid11919306">{{cite journal| author=Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A et al.| title=Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 13 | pages= 975-80 | pmid=11919306 | doi=10.1056/NEJMoa012385 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11919306  }} </ref><ref name="pmid15598646">{{cite journal| author=Agnelli G| title=Prevention of venous thromboembolism in surgical patients. | journal=Circulation | year= 2004 | volume= 110 | issue= 24 Suppl 1 | pages= IV4-12 | pmid=15598646 | doi=10.1161/01.CIR.0000150639.98514.6c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15598646  }} </ref>  
|-
! '''Indications for secondary thromboprophylaxis'''
|-
|
*[[Antiphospholipid syndrome]]
*[[Antiphospholipid syndrome]]
*[[Paroxysmal nocturnal hemoglobinuria]] (PNH)
*[[Paroxysmal nocturnal hemoglobinuria]] (PNH)
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*Concerning family history
*Concerning family history
*[[Male|Male sex]]
*[[Male|Male sex]]
|}


*Recommendations: At present, indefinite anticoagulation at a target INR of 2–3 is recommended only in the following high-risk patients:
{| class="wikitable"
**two or more spontaneous thromboses;
|'''Table 2: Enlist the recommendations for indefinite anticoagulation at a target INR 2–3''' <ref name="pmid11529700">{{cite journal| author=Bauer KA| title=The thrombophilias: well-defined risk factors with uncertain therapeutic implications. | journal=Ann Intern Med | year= 2001 | volume= 135 | issue= 5 | pages= 367-73 | pmid=11529700 | doi=10.7326/0003-4819-135-5-200109040-00013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11529700  }} </ref>
**one spontaneous thrombosis in the case of antithrombin deficiency or the antiphospholipid antibody syndrome;
|-
**one spontaneous life-threatening thrombosis (e.g. near-fatal PE; cerebral, mesenteric or portal vein thrombosis);
! '''High-risk conditions'''
**one spontaneous thrombosis at an unusual site (e.g. mesenteric or cerebral vein);
|-
**one spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event.
|
*Two or more spontaneous thromboses
*One spontaneous thrombosis in the case of antithrombin deficiency or the antiphospholipid antibody syndrome
*One spontaneous life-threatening thrombosis: Near-fatal PE; Cerebral, Mesenteric or Portal vein thrombosis
*One spontaneous thrombosis at an unusual site: Mesenteric or Cerebral vein
*One spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event
|}


==References==
==References==

Latest revision as of 07:22, 28 March 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asiri Ediriwickrema, M.D., M.H.S. [2] Jaspinder Kaur, MBBS[3]

Overview

Secondary prevention strategies following acute thrombosis in patients with thrombophilia include anticoagulation.

Secondary Prevention

  • Long-term therapy to prevent recurrence:
    • 90% risk reduction: The standard therapy for patients with DVT or PE typically includes anticoagulation with warfarin for 3– 12 months at a target INR between 2-3 after initial heparinization course.
    • Recurrences are less common after 6–12 months of discontinuation of anticoagulant therapy and when the initial event is associated with a transient risk factor such as surgery, trauma, etc.
Table 1: Enlist the indications for the secondary prevention[1][2][3][4][5][6][7]
Indications for secondary thromboprophylaxis
Table 2: Enlist the recommendations for indefinite anticoagulation at a target INR 2–3 [8]
High-risk conditions
  • Two or more spontaneous thromboses
  • One spontaneous thrombosis in the case of antithrombin deficiency or the antiphospholipid antibody syndrome
  • One spontaneous life-threatening thrombosis: Near-fatal PE; Cerebral, Mesenteric or Portal vein thrombosis
  • One spontaneous thrombosis at an unusual site: Mesenteric or Cerebral vein
  • One spontaneous thrombosis in the presence of more than a single genetic defect predisposing to a thromboembolic event

References

  1. ↑ Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R; et al. (2016). "Guidance for the treatment of deep vein thrombosis and pulmonary embolism". J Thromb Thrombolysis. 41 (1): 32–67. doi:10.1007/s11239-015-1317-0. PMC 4715858. PMID 26780738.
  2. ↑ DeLoughery TG. Hemostasis and Thrombosis: Springer International Publishing; 2014.
  3. ↑ Cohoon KP, Heit JA (2014). "Inherited and secondary thrombophilia". Circulation. 129 (2): 254–7. doi:10.1161/CIRCULATIONAHA.113.001943. PMC 3979345. PMID 24421360.
  4. ↑ Seligsohn U, Lubetsky A (2001). "Genetic susceptibility to venous thrombosis". N Engl J Med. 344 (16): 1222–31. doi:10.1056/NEJM200104193441607. PMID 11309638.
  5. ↑ Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S; et al. (2012). "Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e278S–325S. doi:10.1378/chest.11-2404. PMC 3278063. PMID 22315265.
  6. ↑ Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A; et al. (2002). "Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer". N Engl J Med. 346 (13): 975–80. doi:10.1056/NEJMoa012385. PMID 11919306.
  7. ↑ Agnelli G (2004). "Prevention of venous thromboembolism in surgical patients". Circulation. 110 (24 Suppl 1): IV4–12. doi:10.1161/01.CIR.0000150639.98514.6c. PMID 15598646.
  8. ↑ Bauer KA (2001). "The thrombophilias: well-defined risk factors with uncertain therapeutic implications". Ann Intern Med. 135 (5): 367–73. doi:10.7326/0003-4819-135-5-200109040-00013. PMID 11529700.

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