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Wei B, Zhou H, Liu G, Zheng Y, Zhang Y, Hao C, Wang Y, Kang H, Lu X, Yuan Y, Meng Q. Risk factors for venous thromboembolism in patients with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2023; 46:181-193. [PMID: 33890837 PMCID: PMC9987783 DOI: 10.1080/10790268.2021.1913561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Patients with spinal cord injury (SCI) are at high risk for venous thromboembolism (VTE). The risk factors for VTE in patients with SCI are complex. OBJECTIVE This meta-analysis was conducted to clarify the risk factors for VTE in patients with SCI. METHODS The Cochrane Library, PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Med Data Database, and VIP Database were searched to identify studies reporting on risk factors for VTE in patients with SCI. RESULTS The meta-analysis included 25 studies. Findings showed that risk of VTE in patients with SCI was significantly associated with middle- and old-age (OR = 2.08, 95%CI, 1.47, 2.95), male sex (OR = 1.41, 95%CI, 1.26, 1.59), complete paralysis (OR = 3.69, 95%CI, 2.60, 5.24), personal/family history of venous thrombosis (OR = 1.95, 95%CI, 1.35, 2.81), history of smoking (OR = 2.67, 95%CI, 1.79, 3.98), lack of compression therapy (OR = 2.44, 95%CI, 1.59, 3.73), presence of lower limb/pelvic fracture (OR = 3.47, 95%CI, 1.79, 6.75), paraplegia (OR = 1.81, 95%CI, 1.49, 2.19), and diabetes (OR = 4.24, 95%CI, 2.75, 6.52). CONCLUSION The meta-analysis identified 9 risk factors for VTE in patients with SCI. Healthcare providers should be aware of the risk factors for VTE when rehabilitating patients with SCI.
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Affiliation(s)
- Bo Wei
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Hongjun Zhou
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Genlin Liu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zheng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Ying Zhang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Chunxia Hao
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yiji Wang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Haiqiong Kang
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Xiaolei Lu
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Yuan Yuan
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Qianru Meng
- Department of Spinal Cord Injury Rehabilitation, China Rehabilitation Research Center, Beijing, People's Republic of China.,China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, People's Republic of China
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Baronti A, Gentile F, Manetti AC, Scatena A, Pellegrini S, Pucci A, Franzini M, Castiglione V, Maiese A, Giannoni A, Pistello M, Emdin M, Aquaro GD, Di Paolo M. Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc? Viruses 2022; 14:v14081644. [PMID: 36016266 PMCID: PMC9413746 DOI: 10.3390/v14081644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccination against coronavirus disease 2019 (COVID-19) is the safest and most effective strategy for controlling the pandemic. However, some cases of acute cardiac events following vaccine administration have been reported, including myocarditis and myocardial infarction (MI). While post-vaccine myocarditis has been widely discussed, information about post-vaccine MI is scarce and heterogenous, often lacking in histopathological and pathophysiological details. We hereby present five cases (four men, mean age 64 years, range 50–76) of sudden death secondary to MI and tightly temporally related to COVID-19 vaccination. In each case, comprehensive macro- and microscopic pathological analyses were performed, including post-mortem cardiac magnetic resonance, to ascertain the cause of death. To investigate the pathophysiological determinants of MI, toxicological and tryptase analyses were performed, yielding negative results, while the absence of anti-platelet factor 4 antibodies ruled out vaccine-induced thrombotic thrombocytopenia. Finally, genetic testing disclosed that all subjects were carriers of at least one pro-thrombotic mutation. Although the presented cases do not allow us to establish any causative relation, they should foster further research to investigate the possible link between COVID-19 vaccination, pro-thrombotic genotypes, and acute cardiovascular events.
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Affiliation(s)
- Arianna Baronti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Francesco Gentile
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
| | - Alice Chiara Manetti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Andrea Scatena
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angela Pucci
- Department of Histopathology, University of Pisa, 56126 Pisa, Italy;
| | - Maria Franzini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy;
| | - Vincenzo Castiglione
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Aniello Maiese
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Alberto Giannoni
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or
| | | | - Marco Di Paolo
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
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Dölek B, Eraslan S, Eroğlu S, Kesim BE, Ulutin T, Yalçiner A, Laleli YR, Gözükirmizi N. Molecular Analysis of Factor V Leiden, Factor V Hong Kong, Factor II G20210A, Methylenetetrahydrofolate Reductase C677T, and A1298C Mutations Related to Turkish Thrombosis Patients. Clin Appl Thromb Hemost 2016; 13:435-8. [PMID: 17911197 DOI: 10.1177/1076029607303341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inherited gene disorders related to the hemostatic system have been documented as risk factors for thrombosis. The roles of factor V Hong Kong (FV Hong Kong), factor V Leiden (FV Leiden), factor II G20210A (FII G20210A), methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations in Turkish patients with thrombosis (270 patients) compared with healthy controls (114 subjects) were evaluated. Polymerase chain reaction—based restriction enzyme analysis was carried out to screen these mutations, and single-strand conformation analysis was established to identify variations using the primers selected for restriction enzyme analysis studies. As a result, a significant relationship was determined among FV Leiden, FII G20210A, and thrombosis. The FV Hong Kong mutation was observed in only 2 patients with pulmonary vein thrombosis who are FV Leiden/FV Hong Kong compound heterozygous for FV gene. MTHFR C677T and A1298C were equally distributed in the patient group compared with the control group. All named mutations were also identified with single-strand conformation analysis, but a new variant/polymorphism during studies was not found. Because some inherited abnormalities are associated with thromboembolic disorders, determining the mutations and gene-to-gene interactions in patients with thrombosis history has a great impact on diagnosis and treatment of these diseases.
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Affiliation(s)
- Bilgen Dölek
- Department of Molecular Biology and Genetics, Istanbul University, Istanbul, Turkey.
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Glueck CJ, Goldenberg N, Wang P, Aregawi D. Ramifications of Four Concurrent Thrombophilic Mutations and One Hypofibrinolytic Mutation. Clin Appl Thromb Hemost 2016; 10:365-71. [PMID: 15497023 DOI: 10.1177/107602960401000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A kindred was examined in which the 48-year-old white female proband with three deep venous thrombosis-pulmonary emboli events had four thrombophilic and one hypofibrinolytic mutations, and in which her 14-year-old asymptomatic daughter had four thrombophilic mutations. The proband was heterozygous for the G1691A factor V Leiden, G20210A prothrombin, and platelet glycoprotein IIIa PL A1/A2 mutations, had high factor VIII (221%), and was homozygous for the 4G4G plasminogen activator inhibitor-1 gene mutation, with high plasminogen activator inhibitor activity (23.7 U/mL). Her 14-year-old daughter was homozygous for the G1691A factor V Leiden and platelet glycoprotein IIb-IIIa PL A2/A2 mutations, compound heterozygous for the C677T and A1298C methylenetetrahydrofolate reductase (MTHFR) mutations, and heterozygous for the G20210A prothrombin mutation, a combination with an estimated likelihood of 1.6 × 10-7. In 247 white healthy controls, there was no V Leiden homozygosity and no V Leiden-prothrombin gene compound heterozygosity. Heterozygosity for the V Leiden and prothrombin gene mutations was 3.2% and 4.1%, respectively. Homozygosity for the platelet glycoprotein IIb-IIIa PL A2A2, PAI-1 gene 4G4G, and C677T MTHFR mutations was 3.2%, 22.7%, and 12%, respectively. The proband will receive anticoagulation therapy for life. Beyond aspirin, avoidance of exogenous estrogens, and enoxaparin prophylaxis during pregnancy, it is not known whether the proband’s daughter should have lifelong anticoagulation therapy, or only after her first thrombotic event.
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Freyburger G, Labrouche S, Hubert C, Bauduer F. Haemostaseome-associated SNPs: has the thrombotic phenotype a greater influence than ethnicity? GMT study from Aquitaine including Basque individuals. Thromb Haemost 2014; 113:66-76. [PMID: 25374097 DOI: 10.1160/th14-02-0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/15/2014] [Indexed: 11/05/2022]
Abstract
The Genetic Markers for Thrombosis (GMT) study compared the relative influence of ethnicity and thrombotic phenotype regarding the distribution of SNPs implicated in haemostasis pathophysiology ("haemostaseome"). We assessed 384 SNPs in three groups, each of 480 subjects: 1) general population of Aquitaine region (Southwestern France) used as control; 2) patients with venous thromboembolism from the same area; and 3) autochthonous Basques, a genetic isolate, who demonstrate unusual characteristics regarding the coagulation system. This study sought to evaluate i) the value of looking for a large number of genes in order to identify new genetic markers of thrombosis, ii) the value of investigating low risk factors and potential preferential associations, iii) the impact of ethnicity on the characterisation of markers for thrombosis. We did not detect any previously unrecognised SNP significantly associated with thrombosis risk or any preferential associations of low-risk factors in patients with thrombosis. The sum of ϰ² values for our 110 significant SNPs demonstrated a smaller genetic distance between patients and controls (321 cumulated ϰ² value) than between Basques and controls (1,570 cumulated ϰ² value). Hence, our study confirms the genetic particularity of Basques especially regarding a significantly lower expression of the non-O blood group (p< 0.0004). This is mitigated by a higher prevalence of factor II Leiden (p< 0.02) while factor V Leiden prevalence does not differ. Numerous other differences covering a wide range of proteins of the haemostaseome may result in an overall different genetic risk for venous thromboembolism.
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Affiliation(s)
- Geneviève Freyburger
- Geneviève Freyburger, Laboratory for Hematology, CHU Pellegrin, 33076 Bordeaux cedex, France, Tel.: +335 57 820 206, Fax: +335 56 79 60 20, E-mail:
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6
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Wang J, Wang C, Chen N, Shu C, Guo X, He Y, Zhou Y. Association between the plasminogen activator inhibitor-1 4G/5G polymorphism and risk of venous thromboembolism: a meta-analysis. Thromb Res 2014; 134:1241-8. [PMID: 25450536 DOI: 10.1016/j.thromres.2014.09.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/02/2014] [Accepted: 09/25/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism was considered to be associated with risk of venous thromboembolism (VTE), while evidence remains inadequate. To provide a more accurate estimation of this relationship, we performed an updated meta-analysis of all eligible studies. MATERIALS AND METHODS A systematical search was performed in PubMed, EMBASE, Wanfang, China National Knowledge Infrastructure (CNKI) and Cqvip databases to identify relevant studies published before March 6(th) 2014. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the fixed/random-effects model using Review Manager 5.1 and STATA 12.0. RESULTS A total of 34 studies with 3561 cases and 5693 controls were analyzed. Overall, significant association between the PAI-1 4G/5G variant and VTE risk in total population (dominant model: OR=1.32, 95%CI: 1.13-1.54) was observed. And this variant was also related to the deep vein thrombosis risk (dominant model: OR=1.60, 95%CI: 1.24-2.06, P=0.0003). In the subgroup analyses on ethnicity, significant results were obtained in both Asians (dominant model: OR=2.08, 95%CI: 1.29-3.35, P=0.003) and Caucasians (dominant model: OR=1.31, 95%CI: 1.10-1.56, P=0.003). However, no significant association was found in patients with provoked VTE. In terms of subgroup analyses on co-existence of other thrombotic risk factors, the PAI-1 4G/5G polymorphism was significantly associated with VTE risk in patients with factor V Leiden mutation (dominant model: OR=1.72, 95%CI: 1.17-2.53), but not in patients with cancer or surgery. CONCLUSION Our findings demonstrate the role of PAI-1 4G/5G polymorphism being a risk candidate locus for VTE susceptibility, especially in patients with other genetic thrombophilic disorders.
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Affiliation(s)
- Jiarong Wang
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Chengdi Wang
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nan Chen
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Chi Shu
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaojiang Guo
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Yazhou He
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yanhong Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R China.
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7
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Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 2013; 28:621-47. [PMID: 23900608 PMCID: PMC3935237 DOI: 10.1007/s10654-013-9825-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 07/02/2013] [Indexed: 12/16/2022]
Abstract
Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.
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Affiliation(s)
- B Simone
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - V De Stefano
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E Leoncini
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - J Zacho
- Department of Clinical Biochemistry, Herlev Hospital,
Copenhagen University Hospital, Herlev, Denmark
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center,
Department of Internal Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda
- Ospedale Maggiore Policlinico, Milan, Italy
| | - J Emmerich
- Hôpital Européen Georges Pompidou, Service
de Médecine Vasculaire, Centre Claude Bernard et Laboratoire
d'Hémostase, Paris, France
| | - E Rossi
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - AR Folsom
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, MN, USA
| | - WY Almawi
- Department of Medical Biochemistry, Arabian Gulf
University, Manama, Bahrain
| | | | - M den Heijer
- Department of Internal Medicine, VU Medical Center, PO-box
7057 1007 MB, Amsterdam, the Netherlands
| | - M Cushman
- Department of Medicine, University of Vermont,
Burlington 05446, USA
| | - S Penco
- Medical Genetics, Clinical Chemistry and Clinical
Pathology Laboratory, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3,
20100 Milan, Italy
| | - A Vaya
- Thrombosis and Hemostasis Unit, Department of Clinical
Pathology, La Fe University Hospital, Valencia, Spain
| | - P Angchaisuksiri
- Department of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
| | - G Okumus
- Department of Pulmonary Diseases, Istanbul Medical
Faculty, Istanbul University, Capa-Istanbul, Turkey
| | - D Gemmati
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - S Cima
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - N Akar
- Ankara University Department of Pediatric Molecular
Genetics, Ankara, Turkey
| | - KI Oguzulgen
- Department of Pulmonary Medicine, Gazi University School
of Medicine, Ankara, Turkey
| | - V Ducros
- Département de Biochimie, Toxicologie et
Pharmacologie, Centre Hospitalier Universitaire, BP 217, 38043 Grenoble,
France
| | - C Lichy
- Department of Neurology, Klinikum Memmingen,
Bismarckstrasse 23, 87700 Memmingen, Germany
| | - C Fernandez-Miranda
- Servicio de Medicina Interna, Hospital Universitario 12
de Octubre, Madrid, Spain
| | - A Szczeklik
- Dept of Medicine, Jagiellonian University School of
Medicine, Cracow, Poland
| | - JA Nieto
- Departments of Internal Medicine, Virgen de la Luz
Hospital, Cuenca, Spain
| | - JD Torres
- Grupo de Investigación en Trombosis, Universidad
de Antioquia–Hospital Universitario San Vicente de Paúl,
Medellín, Colombia
| | | | - P Ivanov
- Department of Biochemistry, University of Medicine,
Pleven, Bulgaria
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Neurología y
Neurocirugía Manuel Velasco Suárez, Mexico
| | - VM Shmeleva
- Russian Institute of Haematology and Transfusion, St.
Petersburg, 2-nd Sovietskaya 16, Russia
| | - M Stegnar
- Department of Vascular Diseases, University Medical
Centre Ljubljana, Ljubljana, Slovenia
| | - D Ogunyemi
- Perinatology Unit, Morristown Memorial Hospital, New
Jersey, USA
| | - SS Eid
- King Hussein Medical Center, Princess Iman Research
Center for Laboratory Sciences, Amman, Jordan
| | - N Nicolotti
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E De Feo
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - S Boccia
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
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Kotwal S, Kawaguchi S, Hughes A, Cammisa F, Zhang K, Salvati E, Girardi F. Thrombophilic abnormalities in patients with or without pulmonary embolism following elective spinal surgery: a pilot study. HSS J 2013; 9:32-5. [PMID: 24426842 PMCID: PMC3640719 DOI: 10.1007/s11420-012-9318-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 11/19/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Significance of the thrombophilic abnormalities in development of venous thromboembolism (VTE) has been studies with total hip arthroplasty and acute traumatic spinal cord injury. However, their role as risk factors for VTE in elective spinal surgery remains to be determined. QUESTIONS/PURPOSES To determine the role of thrombophilic abnormalities in the development of pulmonary embolism (PE) following elective spine surgery. METHODS Case and control groups were created in patients who had undergone elective spinal surgery for degenerative conditions. The PE group comprised 12 patients whose post-operative course was complicated by development of PE. The control group included 12 patients with an uneventful post-operative course. Demographic data including age, gender and surgical procedures were matched between the PE group and the control group. Both groups were evaluated for thrombophilic and hypofibrinolytic risk factors at 3 months post-operatively or later. Blood tests were performed to measure fasting serum homocysteine, antithrombin III, and protein C. Molecular genetic testing was conducted for detection of the plasminogen activator inhibitor-1 4G/4G, and prothrombin 3 UTR gene mutations. RESULTS Heterozygous mutation (G20201A) of prothrombin was detected in two patients (16.7%) in the PE group, whereas no such mutation was noted in the control group. Plasminogen activator inhibitor-1 4G/4G homozygous mutation was seen in three in the PE group and two in the control group. Of homocysteine, antithrombin III and protein C, only one patient in each group showed abnormal levels of homocysteine. In total, there half of the patients in the PE group had at least one thrombophilic abnormality, whereas three (25%) patients showed such abnormality in the control group. CONCLUSION These findings suggest the involvement of thrombophilic abnormalities, especially the heterozygous G20201A mutation, in the development of PE in patients undergoing elective spinal surgery.
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Affiliation(s)
- Suhel Kotwal
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Department of Orthopedic Surgery, Truman Medical Center, Hospital Hill, 2301 Holmes Street, Kansas City, MO 64108 USA
| | - Satoshi Kawaguchi
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo, 060-8543 Japan
| | - Alexander Hughes
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell College of Medicine, New York, NY 10065 USA
| | - Frank Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell College of Medicine, New York, NY 10065 USA
| | - Kai Zhang
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell College of Medicine, New York, NY 10065 USA
| | - Eduardo Salvati
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell College of Medicine, New York, NY 10065 USA
| | - Federico Girardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ,Weill Cornell College of Medicine, New York, NY 10065 USA
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9
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Cinemre H, Bilir C, Akdemir N. Isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. Clin Appl Thromb Hemost 2009; 16:708-10. [PMID: 19825918 DOI: 10.1177/1076029609347899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Isolated renal vein thrombosis is very rare without the presence of nephrotic syndrome. It is more common in the newborns and infants. Whereas major risk factors in adults are the procoagulant states such as protein C or S deficiency, factor V Leiden mutation, primary or secondary antiphospholipid syndrome, severe hypothyroidism, and trauma. Here, we report a case of isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. It should be noted that the presence of MTHFR-1298 and PAI-1 4G gene mutations together might be one of the examples of genetic mutation combinations that increase the likelihood of a thrombotic event.
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Affiliation(s)
- Hakan Cinemre
- Department of Internal Medicine, Duzce University, Turkey
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10
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Caner M, Bircan R, Sevinç D, Benli F, Güney AI, Kurtoglu N. MTHFR , prothrombin and Factor V gene variants in Turkish patients with coronary artery stenosis. Genet Mol Biol 2008. [DOI: 10.1590/s1415-47572008005000023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Müge Caner
- Department of Medical Biology, Maltepe University, School of Medicine, Turkey
| | - Rifat Bircan
- Department of Molecular Biology, Namik Kemal University, Faculty of Arts and Sciences, Turkey
| | - Deniz Sevinç
- Department of Medical Biology, Maltepe University, School of Medicine, Turkey
| | - Fehime Benli
- Department of Biochemistry, Maltepe University, School of Medicine, Turkey
| | - A. Ilter Güney
- Department of Medical Biology, Marmara University, Istanbul Turkey
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11
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Eroglu A, Ulu A, Akar N. Plasminogen activator inhibitor-1 gene 4G/5G polymorphism in cancer patients with and without thrombosis. J Thromb Thrombolysis 2006; 22:111-2. [PMID: 17008976 DOI: 10.1007/s11239-006-9054-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aydan Eroglu
- Department of Surgery and Surgical Oncology, Numune State Hospital, Konya, Turkey
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12
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Andreassi MG, Botto N, Maffei S. Factor V Leiden, prothrombin G20210A substitution and hormone therapy: indications for molecular screening. Clin Chem Lab Med 2006; 44:514-21. [PMID: 16681418 DOI: 10.1515/cclm.2006.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous thromboembolism is a well-known complication of oral contraception and hormonal replacement therapy. Inherited thrombophilia is viewed as an important determinant in modulating the effects of estrogens on thrombotic risk. An increasing number of kits for thrombophilic mutations [factor V Leiden, G20210A prothrombin and methylenetetrahydrofolate reductase (MTHFR) C677T genes] are becoming commercially available, and screening for inherited thrombotic risk is among the most requested genetic tests in molecular diagnostic laboratories. However, the question of routine genetic screening for thrombophilia before prescribing hormones is still a matter of debate. The purpose of this article is to discuss the usefulness and practical applications of thrombotic genetic testing to identify which women should be tested to improve both the safety and efficacy of individualized estrogen therapy.
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Affiliation(s)
- Maria Grazia Andreassi
- Laboratory of Cellular Biology and Genetics, CNR-Institute of Clinical Physiology, G. Pasquinucci Hospital, Via Aurelia Sud-Montepepe, 54100 Massa, Italy.
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13
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Sharma P, Senthilkumar RD, Brahmachari V, Sundaramoorthy E, Mahajan A, Sharma A, Sengupta S. Mining literature for a comprehensive pathway analysis: a case study for retrieval of homocysteine related genes for genetic and epigenetic studies. Lipids Health Dis 2006; 5:1. [PMID: 16430779 PMCID: PMC1395315 DOI: 10.1186/1476-511x-5-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 01/23/2006] [Indexed: 02/07/2023] Open
Abstract
Homocysteine is an independent risk factor for cardiovascular diseases. It is also known to be associated with a variety of complex disorders. While there are a large number of independent studies implicating homocysteine in isolated pathways, the mechanism of homocysteine induced adverse effects are not clear. Homocysteine-induced modulation of gene expression through alteration of methylation status or by hitherto unknown mechanisms is predicted to lead to several pathological conditions either directly or indirectly. In the present manuscript, using literature mining approach, we have identified the genes that are modulated directly or indirectly by an elevated level of homocysteine. These genes were then placed in appropriate pathways in an attempt to understand the molecular basis of homocysteine induced complex disorders and to provide a resource for selection of genes for polymorphism screening and analysis of mutations as well as epigenetic modifications in relation to hyperhomocysteinemia. We have identified 135 genes in 1137 abstracts that either modulate the levels of homocysteine or are modulated by elevated levels of homocysteine. Mapping the genes to their respective pathways revealed that an elevated level of homocysteine leads to the atherosclerosis either by directly affecting lipid metabolism and transport or via oxidative stress and/or Endoplasmic Reticulum (ER) stress. Elevated levels of homocysteine also decreases the bioavailability of nitric oxide and modulates the levels of other metabolites including S-adenosyl methionine and S-adenosyl homocysteine which may result in cardiovascular or neurological disorders. The ER stress emerges as the common pathway that relates to apoptosis, atherosclerosis and neurological disorders and is modulated by levels of homocysteine. The comprehensive network collated has lead to the identification of genes that are modulated by homocysteine indicating that homocysteine exerts its effect not only through modulating the substrate levels for various catalytic processes but also through regulation of expression of genes involved in complex diseases.
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Affiliation(s)
- Priyanka Sharma
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
- Dr. B. R. Ambedkar Centre for Biomedical Research, University of Delhi, Delhi-110007, India
| | - RD Senthilkumar
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Vani Brahmachari
- Dr. B. R. Ambedkar Centre for Biomedical Research, University of Delhi, Delhi-110007, India
| | - Elayanambi Sundaramoorthy
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Anubha Mahajan
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Amitabh Sharma
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Shantanu Sengupta
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
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14
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Den Heijer M, Lewington S, Clarke R. Homocysteine, MTHFR and risk of venous thrombosis: a meta-analysis of published epidemiological studies. J Thromb Haemost 2005; 3:292-9. [PMID: 15670035 DOI: 10.1111/j.1538-7836.2005.01141.x] [Citation(s) in RCA: 290] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT It has been suggested that elevated total plasma homocysteine levels are associated with the risk of venous thrombosis. OBJECTIVE To assess the relationship of homocysteine and the MTHFR 677TT genotype and the risk of venous thrombosis by conducting a meta-analysis of all relevant studies. DATA SOURCES AND SELECTION Studies (case-control or nested case-control) were identified by searches of electronic literature for relevant reports published before July 2003 on homocysteine and the MTHFR 677TT genotype and venous thrombosis as an end-point, by hand-searching reference lists of original articles (including meta-analyses) on this topic and by contact with investigators in the field. DATA EXTRACTION A meta-analysis of 24 retrospective (n = 3289 cases) and three prospective studies (n = 476 cases) was carried out to examine the association of homocysteine with venous thrombosis. A meta-analysis of 53 studies (n = 8364 cases) of the MTHFR 677TT genotype (that increases homocysteine) was carried out to assess if this association is causal. DATA SYNTHESIS A 5 micromol L(-1) higher measured homocysteine level was associated with a 27% (95% CI: 1-59) higher risk of venous thrombosis in prospective studies and a 60% (95% CI: 10-134) higher risk in retrospective studies. The 677TT genotype was associated with a 20% (95% CI: 8-32) higher risk of venous thrombosis compared with the 677CC genotype. In contrast with non-American studies, the 677TT genotype had no effect on venous thrombosis in North America, due probably to the higher intake of folate and riboflavin in North America. CONCLUSION This meta-analysis of prospective and retrospective studies demonstrates a modest association of homocysteine with venous thrombosis. The elevated risk associated with the MTHFR 677TT genotype provides some support for causality.
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Affiliation(s)
- M Den Heijer
- Department of Endocrinology (531), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands.
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15
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Sidney S, Petitti DB, Soff GA, Cundiff DL, Tolan KK, Quesenberry CP. Venous thromboembolic disease in users of low-estrogen combined estrogen-progestin oral contraceptives. Contraception 2004; 70:3-10. [PMID: 15208046 DOI: 10.1016/j.contraception.2004.02.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 01/06/2004] [Accepted: 02/02/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the relationship between venous thromboembolic disease (VTE) and use of low-estrogen dose (<50 microg) combined estrogen-progestin oral contraceptives (OC) and three thrombosis-related gene mutations in a United States population. DESIGN This case-control study was conducted in 1998-2000 among women ages 15-44 years who were members of the Kaiser Permanente Medical Care Program [KPMCP] (Northern and Southern California). Cases were women with incident VTE; about three times as many women frequency matched for age were randomly selected as controls from the KPMCP membership in the same years. Data were collected in a 1 h face-to-face interview; blood was drawn to extract DNA to test for gene polymorphisms. The analysis data set comprised 196 cases (mean age 35.3 years) and 746 controls (mean age 36.2 years). RESULTS The adjusted odds ratio (OR) for VTE associated with current OC use was 4.07 (95% confidence interval [CI]: 2.77-6.00). The OR associated with OC use was higher for women who were obese than in the nonobese (p = 0.01 for likelihood test for interaction) and in women without predisposing medical conditions (p = 0.02 for interaction). The adjusted OR for VTE was 7.10 (95% CI: 2.33-21.61) in women with factor V Leiden (G1691A) mutation, 2.83 (95% CI: 0.70-11.63) in women with prothrombin G20210A mutation and 0.26 (95% CI: 0.10-0.65) in women with the MTHFR C677T mutation. The OR for VTE in OC users with factor V Leiden mutation (11.32) was elevated more than in OC users without the mutation (3.20) and women with the mutation who were non-OC users (8.42), but confidence intervals overlapped. CONCLUSIONS The risk of VTE is increased in users of low-estrogen OC formulations. Obese women appear to be at greater risk of VTE when using OCs.
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Affiliation(s)
- Stephen Sidney
- Division of Research, Kaiser Permanente Medical Care Program (Northern California), 2000 Broadway, Oakland 94612, USA.
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16
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Gutiérrez Tous MR, Couto Caro MC, García-Donas Gabaldón G, Simón Pilo I. Prevalencia de los polimorfismos genéticos asociados a trombofilia en población sana del sur de España. Med Clin (Barc) 2004; 122:556-7. [PMID: 15117652 DOI: 10.1016/s0025-7753(04)74303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Berrut G, Ghali A, Quere I, Ternisien C, Gallois I, Roy PM, Marre M, Fressinaud P. [A common mutation C677T in the 5,10-methyltetrahydrofolate reductase gene is associated to idiopathic deep venous thrombosis]. Rev Med Interne 2003; 24:569-76. [PMID: 12951177 DOI: 10.1016/s0248-8663(03)00210-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Moderate hyperhomocysteinemia is a risk factor for deep venous thrombosis. The homozygous C677T methylenetetrahydrofolate reductase (MTHFR) mutation is associated with increased level of total plasma homocysteine. The association between homozygous C677T mutation and deep venous thrombosis is still controversial. METHOD In order to evaluate this association, we studied the prevalence of C677T mutation in 168 patients with confirmed deep venous thrombosis; 31 with an idiopathic deep venous thrombosis (group A) and 137 with thromboembolic event explained by one or more clinical and/or biological risk factors (group B). RESULTS The distribution of genotypes was different between group A and B [++/+ -/- -(n(%))] : 9(29)/10(32)/12(39) vs 16(12)/57(42)/64(46) (chi(2) : 6.03; P: 0.049). The comparison between homozygotes and the two other genotypes showed significant statistical relationship between homozygous genotype and idiopathic character of deep venous thrombosis (chi(2) : 6.01; P : 0.014; OR : 3.09 [IC 95% : 1.06-8.53]). CONCLUSION These results suggest that homozygous C677T methylenetetrahydrofolate reductase mutation could be considered as a genetic risk factor for venous thrombosis.
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Affiliation(s)
- G Berrut
- Service de médecine B, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
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18
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Adamczuk YP, Iglesias Varela ML, Martinuzzo ME, Cerrato GS, Forastiero RR. Central retinal vein occlusion and thrombophilia risk factors. Blood Coagul Fibrinolysis 2002; 13:623-6. [PMID: 12439148 DOI: 10.1097/00001721-200210000-00007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of the present study was to investigate the role of risk factors predisposing to thrombosis in patients with central retinal vein occlusion (CRVO). We prospectively examined 37 consecutive patients with CRVO, and 144 healthy controls, for major and potential inherited and acquired thrombophilic risk factors. Among them, only the prevalence of hyperhomocysteinaemia (10/37, 27.0%) and antiphospholipid antibodies positivity (5/37, 13.5%) were significantly higher in patients with respect to controls (5.5%, P < 0.001 and 2.1%, P < 0.01, respectively). Both hyperhomocysteinaemia and antiphospholipid antibodies seem to be associated with CRVO. A search for acquired thrombophilia is advisable in patients with CRVO.
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Affiliation(s)
- Y P Adamczuk
- Department of Haematology, Thrombosis and Haemostasis, Favaloro University, Buenos Aires, Argentina
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