Thrombophilia natural history, complications and prognosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 16: | Line 16: | ||
==Complications== | ==Complications== | ||
*The primary complication of thrombophilia is the development of [[Thrombus|blood clots]] | *The primary complication of thrombophilia is the development of [[Thrombus|blood clots]] | ||
*Common complications of thrombophilia include [[deep vein thrombosis]] and [[pulmonary embolism]] | *Common complications of thrombophilia include [[deep vein thrombosis]] and [[pulmonary embolism]]. Data were extracted from multiple sources.<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><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><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> | ||
*Deep venous thrombosis has two major complications: pulmonary embolism, which is acute and life-threatening, and postthrombotic syndrome (PTS) with chronic venous ulceration (CVU). | |||
'''Table 1: The risk of future thrombosis in patients with thrombophilia:''' | '''Table 1: The risk of future thrombosis in patients with thrombophilia:''' | ||
| Line 90: | Line 92: | ||
| 50 | | 50 | ||
|} | |} | ||
==Prognosis== | ==Prognosis== | ||
Revision as of 06:23, 2 March 2021
|
Thrombophilia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Thrombophilia natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Thrombophilia natural history, complications and prognosis |
|
FDA on Thrombophilia natural history, complications and prognosis |
|
CDC on Thrombophilia natural history, complications and prognosis |
|
Thrombophilia natural history, complications and prognosis in the news |
|
Blogs on Thrombophilia natural history, complications and prognosis |
|
Risk calculators and risk factors for Thrombophilia natural history, complications and prognosis |
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
The annual thrombotic risks are variable and depend on the underlying thrombophilia.[1]
Natural History
- If left untreated, the annual incidence of incident thrombosis in asymptomatic patients with Factor V Leiden and Prothrombin G20210A is low (<0.06%).[2] The risk is approximately equivalent to treatment with oral contraceptives.
- In patients on oral anticoagulant therapy for venous thromboembolism, the annual incidence of significant bleeds is approximately 2-3%.[3]
- Inherited thrombophilia from Factor V Leiden and Prothrombin G20210A did not predict for recurrent thrombosis.[4][5]
- In untreated patients with protein C, protein S, and antithrombin deficiencies, there is an increased risk for recurrent thrombosis.[4][6]
- Oral contraceptives, hormone replacement therapy, and pregnancy can significantly increase thrombotic risk in patients with thrombophilia.[7]
- Certain high risk thrombophilias require indefinite anticoagulation.
Complications
- The primary complication of thrombophilia is the development of blood clots
- Common complications of thrombophilia include deep vein thrombosis and pulmonary embolism. Data were extracted from multiple sources.[1][2][7]
- Deep venous thrombosis has two major complications: pulmonary embolism, which is acute and life-threatening, and postthrombotic syndrome (PTS) with chronic venous ulceration (CVU).
Table 1: The risk of future thrombosis in patients with thrombophilia:
| Thrombotic risk[2] | Thrombophilic state |
|---|---|
| Modest | Trauma/General surgery, Age > 60, Immobilization, Pregnancy, Hormone therapies, Factor V Leiden heterozygosity, Prothrombin mutation, Homocysteinemia, Increased factor VIII levels, Increased factor IX levels, Increased factor XI levels |
| Intermediate | Protein C and S deficiency, Dysfibrogenemia |
| High | Malignancy, APLS/Lupus anticoagulant, Myeloproliferative disorders/hyperviscosity, PNH, Orthopedic surgery, Antithrombin deficiency, Factor V Leiden homozygosity |
The effect of concurrent hormone exposure on incident thrombosis and thrombotic risk in patients with thrombophilia:
| Thrombophilic state | Annual Incidence (%) | Relative Risk |
|---|---|---|
| Normal | 0.008 | 1 |
| Factor V Leiden heterozygous | 0.06 | 3-10 |
| Factor V Leiden homozygous | 0.5-1 | 80 |
| Prothrombin G20210A | 0.02 | 1-5 |
| Oral contraceptive (OCP) | 0.03 | 4 |
| OCP and factor V leiden heterozygous | 0.3 | 35 |
| OCP and factor V leiden homozygous | 100 | |
| OCP and prothrombin G20210A | 16 | |
| OCP and protein C/S, or antithrombin III deficiency | 9.7 | |
| Pregnancy | 7 | |
| Pregnancy and factor V leiden heterozygous | 35 | |
| Cancer | 5 | |
| History of venous thrombosis | 50 |
Prognosis
The prognosis depends on the underlying thrombophilia as each form has a different associated thrombotic risk. Patients who develop multiple or atypical clots, arterial thrombosis, or life-threatening thrombosis have worse prognosis.
Thrombophilias generally associated with worse prognosis include:
- Antiphospholipid Syndrome
- Paroxysmal nocturnal hemoglobinuria
- Antithrombin III deficiency
- Factor V Leiden homozygosity
Certain thrombophilic conditions are high risk and require consideration for lifelong anticoagulation. In these cases, 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
- ↑ 1.0 1.1 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 2.2 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.
- ↑ 4.0 4.1 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.
- ↑ De Stefano V, Simioni P, Rossi E, Tormene D, Za T, Pagnan A; et al. (2006). "The risk of recurrent venous thromboembolism in patients with inherited deficiency of natural anticoagulants antithrombin, protein C and protein S." Haematologica. 91 (5): 695–8. PMID 16670075.
- ↑ 7.0 7.1 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.