Thrombophilia natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
==Natural History== | ==Natural History== | ||
* Refer to the [[Thrombophilia_history_and_symptoms|clinical symptoms]] section regarding early clinical features of patients with thrombophilia. | |||
* Annual thrombotic risks are variable and depend on the underlying thrombophilia<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= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11529700 }} </ref>. | |||
* If left untreated, the annual incidence of incident thrombosis in asymptomatic patients with factor V leidin and prothrombin G20210A (<0.02%) is low<ref name="pmid15254285">{{cite journal| author=Bates SM, Ginsberg JS| title=Clinical practice. Treatment of deep-vein thrombosis. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 3 | pages= 268-77 | pmid=15254285 | doi=10.1056/NEJMcp031676 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15254285 }} </ref>. The risk is approximately equivalent to treatment with oral contraceptives (OCPs). Whereas the annual incidence of significant bleeds is approximately 2-3%<ref name="pmid14644891">{{cite journal| author=Linkins LA, Choi PT, Douketis JD| title=Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. | journal=Ann Intern Med | year= 2003 | volume= 139 | issue= 11 | pages= 893-900 | pmid=14644891 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14644891 }} </ref>. | |||
* Studies performed by Christiansen et al and Baglin et al did revealed that inherited thrombophilia did not predict for recurrent thrombosis<ref name="pmid15900005">{{cite journal| author=Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR| title=Thrombophilia, clinical factors, and recurrent venous thrombotic events. | journal=JAMA | year= 2005 | volume= 293 | issue= 19 | pages= 2352-61 | pmid=15900005 | doi=10.1001/jama.293.19.2352 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15900005 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213089 Review in: Evid Based Med. 2006 Apr;11(2):59] </ref><ref name="pmid12932383">{{cite journal| author=Baglin T, Luddington R, Brown K, Baglin C| title=Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. | journal=Lancet | year= 2003 | volume= 362 | issue= 9383 | pages= 523-6 | pmid=12932383 | doi=10.1016/S0140-6736(03)14111-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12932383 }} </ref>. | |||
* OCPs, hormone replacement therapy, and pregnancy can significantly increase thrombotic risk in patients with thrombophilia<ref name="pmid18501222">{{cite journal| author=Dalen JE| title=Should patients with venous thromboembolism be screened for thrombophilia? | journal=Am J Med | year= 2008 | volume= 121 | issue= 6 | pages= 458-63 | pmid=18501222 | doi=10.1016/j.amjmed.2007.10.042 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18501222 }} </ref>. | |||
* Certain high risk thrombophilias require indefinate [[anticoagulant|anticoagulation]]. | |||
==Complications== | ==Complications== | ||
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==Prognosis== | |||
*Certain thrombophilic conditions are high risk and require consideration for lifelong anticoagulation. Expert consultation is recommended. | |||
== | {| class="wikitable" | ||
! style="font-weight: bold;" | Possible indications for lifelong/prophylactic anticoagulation | |||
|- | |||
| Antiphospholipid syndrome | |||
|- | |||
| Paroxysmal nocturnal hemoglobinuria | |||
|- | |||
| Recurrent thrombosis regardless of underlying thrombophilia | |||
|- | |||
| History of life-threatening thrombosis or atypical locations | |||
|- | |||
| Malignancy with history of thrombosis | |||
|} | |||
==References== | ==References== |
Revision as of 23:00, 25 June 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Asiri Ediriwickrema, M.D., M.H.S. [2]
Overview
Natural History
- Refer to the clinical symptoms section regarding early clinical features of patients with thrombophilia.
- Annual thrombotic risks are variable and depend on the underlying thrombophilia[1].
- If left untreated, the annual incidence of incident thrombosis in asymptomatic patients with factor V leidin and prothrombin G20210A (<0.02%) is low[2]. The risk is approximately equivalent to treatment with oral contraceptives (OCPs). Whereas the annual incidence of significant bleeds is approximately 2-3%[3].
- Studies performed by Christiansen et al and Baglin et al did revealed that inherited thrombophilia did not predict for recurrent thrombosis[4][5].
- OCPs, hormone replacement therapy, and pregnancy can significantly increase thrombotic risk in patients with thrombophilia[6].
- Certain high risk thrombophilias require indefinate anticoagulation.
Complications
Thrombophilic state | Thrombotic risk[2] |
---|---|
Trauma/General surgery | Modest |
Age > 60 | Modest |
Immobilization | Modest |
Pregnancy | Modest |
Hormone therapies | Modest |
Factor V Leiden heterozygosity | Modest |
Prothrombin mutation | Modest |
Homocysteinemia | Modest |
Increased factor VIII levels | Modest |
Increased factor IX levels | Modest |
Increased factor XI levels | Modest |
Protein C and S deficiency | Intermediate |
Dysfibrogenemia | Intermediate |
Malignancy | High |
APLS/Lupus anticoagulant | High |
Myeloproliferative disorders/hyperviscosity | High |
PNH | High |
Orthopedic surgery | High |
Antithrombin deficiency | High |
Factor V Leiden homozygosity | High |
Prognosis
- Certain thrombophilic conditions are high risk and require consideration for lifelong anticoagulation. Expert consultation is recommended.
Possible indications for lifelong/prophylactic anticoagulation |
---|
Antiphospholipid syndrome |
Paroxysmal nocturnal hemoglobinuria |
Recurrent thrombosis regardless of underlying thrombophilia |
History of life-threatening thrombosis or atypical locations |
Malignancy with history of thrombosis |
References
- ↑ Bauer KA (2001). "The thrombophilias: well-defined risk factors with uncertain therapeutic implications". Ann Intern Med. 135 (5): 367–73. PMID 11529700.
- ↑ 2.0 2.1 Bates SM, Ginsberg JS (2004). "Clinical practice. Treatment of deep-vein thrombosis". N Engl J Med. 351 (3): 268–77. doi:10.1056/NEJMcp031676. PMID 15254285.
- ↑ Linkins LA, Choi PT, Douketis JD (2003). "Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis". Ann Intern Med. 139 (11): 893–900. PMID 14644891.
- ↑ Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR (2005). "Thrombophilia, clinical factors, and recurrent venous thrombotic events". JAMA. 293 (19): 2352–61. doi:10.1001/jama.293.19.2352. PMID 15900005. Review in: Evid Based Med. 2006 Apr;11(2):59
- ↑ Baglin T, Luddington R, Brown K, Baglin C (2003). "Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study". Lancet. 362 (9383): 523–6. doi:10.1016/S0140-6736(03)14111-6. PMID 12932383.
- ↑ Dalen JE (2008). "Should patients with venous thromboembolism be screened for thrombophilia?". Am J Med. 121 (6): 458–63. doi:10.1016/j.amjmed.2007.10.042. PMID 18501222.