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Tetsuhara K, Ishiguro A, Michihata N, Sensaki S, Nakadate H, Kimura Y, Tomizawa D, Matsumoto K. Pediatric Thromboembolism in Japan. Indian J Pediatr 2016; 83:1077-81. [PMID: 27053184 DOI: 10.1007/s12098-016-2094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the clinical and epidemiologic characteristics of thromboembolism in Japanese children. METHODS Clinical data of 77 patients with thromboembolism from a national tertiary pediatric care center were reviewed. RESULTS Incidence of thromboembolism was calculated to be 15 per 10,000 hospital admissions. Infants younger than one year of age made up the largest age group (25 patients, including nine neonates younger than 30 d). The occurrence of thromboembolism increased over the years in the index population. Thromboembolism was diagnosed as follows: portal vein thrombosis (n = 15), obstruction of central venous catheter (n = 13) and cerebral infarction (n = 9). Among the 77 patients, there were eight mortalities and six significant sequelae. CONCLUSIONS In pediatric care, especially in intensive care, we should pay more attention to thromboembolism in order to detect it promptly.
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Affiliation(s)
- Kenichi Tetsuhara
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan. .,Division of Emergency Service and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Akira Ishiguro
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Division of Hematology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nobuaki Michihata
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Sonoko Sensaki
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Hisaya Nakadate
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.,Division of Hematology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yui Kimura
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
| | - Daisuke Tomizawa
- Division of Hematology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Division of Hematology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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Min SK, Kim YH, Joh JH, Kang JM, Park UJ, Kim HK, Chang JH, Park SJ, Kim JY, Bae JI, Choi SY, Kim CW, Park SI, Yim NY, Jeon YS, Yoon HK, Park KH. Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines. Vasc Specialist Int 2016; 32:77-104. [PMID: 27699156 PMCID: PMC5045251 DOI: 10.5758/vsi.2016.32.3.77] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 01/28/2023] Open
Abstract
Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.
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Affiliation(s)
- Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University College of Medicine, Daegu,
Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University College of Medicine, Incheon,
Korea
| | - Ui Jun Park
- Department of Surgery, Keimyung University College of Medicine, Daegu,
Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu,
Korea
| | - Jeong-Hwan Chang
- Department of Surgery, Chosun University College of Medicine, Gwangju,
Korea
| | - Sang Jun Park
- Department of Surgery, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jang Yong Kim
- Department of Surgery, Catholic University College of Medicine,
Korea
| | - Jae Ik Bae
- Mint Intervention Clinic, Seongnam,
Korea
| | - Sun Young Choi
- Department of Radiology, Ewha Womans University College of Medicine, Seoul,
Korea
| | - Chang Won Kim
- Department of Radiology, Pusan National University School of Medicine, Yangsan,
Korea
| | - Sung Il Park
- Department of Radiology, Yonsei University College of Medicine, Seoul,
Korea
| | - Nam Yeol Yim
- Department of Radiology, Chonnam National University College of Medicine, Gwangju,
Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon,
Korea
| | - Hyun-Ki Yoon
- Department of Radiology, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ki Hyuk Park
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu,
Korea
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3
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Global prevalence of prothrombin gene mutation G20210A and implications in women's health. Blood Coagul Fibrinolysis 2016; 27:481-9. [DOI: 10.1097/mbc.0000000000000562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Kallel A, Sbaï MH, Sédiri Y, Feki M, Mourali MS, Mechmeche R, Jemaa R, Kaabachi N. Association Between the G20210A Polymorphism of Prothrombin Gene and Myocardial Infarction in Tunisian Population. Biochem Genet 2016; 54:653-64. [PMID: 27306359 DOI: 10.1007/s10528-016-9744-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/27/2016] [Indexed: 01/20/2023]
Abstract
The prothrombin is the precursor of the serine protease thrombin, a key enzyme in homeostasis. Prothrombin G20210A polymorphism (rs1799963) was described as a moderate risk factor for venous thrombosis because this mutation is associated with prothrombin elevated levels which may lead to an imbalance between the procoagulant, anticoagulant, and fibrinolytic system. 20210A carriers have an increased risk of thrombosis. In this study, we proposed to determine the prevalence of 20210A prothrombin variant among Tunisian population, and to evaluate the potential relevance of this variant with myocardial infarction. This study included 1290 unrelated Tunisians (1007 male and 283 female) divided in two groups: Four hundred and eighty-seven MI patients (mean age: 52.64 ± 8.98 years) and 803 apparently healthy controls (mean age: 51 ± 8.99). The prothrombin G20210A polymorphism was carried out by polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) analysis. The distribution of genotypes was in accordance with Hardy-Weinberg equilibrium (p > 0.05). A significant difference in genotype distribution and allele frequency was observed between patients and controls. Male patients with MI had a frequency of 97 % for GG genotype and 3 % for GA+AA genotypes. The control group had a frequency of 99 % for the GG genotype and 1 % for the GA+AA genotypes which is significantly lower than the frequency found in patients (p = 0.01). The same genotype frequencies were found in women (p = 0.032). The MI patient group showed a significantly higher frequency of 20210A allele compared to controls 0.02 versus 0.01 [OR = 3.60 (95 % CI = 1.29-10.53), p = 0.005] in men and 0.015 versus 0.068 [OR = 4.68 (95 % CI = 1.60-14.26), p = 0.001] in women. Our work showed a significant but not independent association between the G20210A polymorphism of the prothrombin gene and MI in the Tunisian population.
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Affiliation(s)
- Amani Kallel
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Hedi Sbaï
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Yousra Sédiri
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Moncef Feki
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Rachid Mechmeche
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Riadh Jemaa
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia.
| | - Naziha Kaabachi
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
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Hamasaki N, Kuma H, Tsuda H. Activated protein C anticoagulant system dysfunction and thrombophilia in Asia. Ann Lab Med 2012; 33:8-13. [PMID: 23301217 PMCID: PMC3535202 DOI: 10.3343/alm.2013.33.1.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/21/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022] Open
Abstract
Thrombophilia that is common among Caucasians is caused by genetic polymorphisms of coagulation factor V Leiden (R506Q) and prothrombin G20210A. Unlike that in Caucasians, thrombophilia that is common in the Japanese and Chinese involve dysfunction of the activated protein C (APC) anticoagulant system caused by abnormal protein S and protein C molecules. Approximately 50% of Japanese and Chinese individuals who develop venous thrombosis have reduced activities of protein S. The abnormal sites causing the protein S molecule abnormalities are distributed throughout the protein S gene, PROS1. One of the most common abnormalities is protein S Tokushima (K155E), which accounts for about 30% of the protein S molecule abnormalities in the Japanese. Whether APC dysfunction occurs in other Asian countries is an important aspect of mapping thrombophilia among Asians. International surveys using an accurate assay system are needed to determine this.
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Affiliation(s)
- Naotaka Hamasaki
- Department of Clinical Chemistry, Faculty of Pharmaceutical Sciences, Natagaki International University, Nagasaki, Japan.
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New quantitative total protein S-assay system for diagnosing protein S type II deficiency: clinical application of the screening system for protein S type II deficiency. Blood Coagul Fibrinolysis 2012; 23:56-63. [PMID: 22157257 DOI: 10.1097/mbc.0b013e32834ddefd] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Venous thromboembolism (VTE) incidence is rising rapidly in Japan with lifestyle westernization and aging. Deficiency of protein S, an important blood coagulation regulator, is a risk factor for VTE. Protein S deficiency prevalence in Asians is approximately 10 times that in Caucasians and that of protein S type II deficiency, associated with the protein S Tokushima mutation (K155E), is quite high in Japan. However, currently available methods for measuring protein S are not precise enough for detection of this deficiency. We developed a novel assay system for precise simultaneous determinations of total protein S activity and total protein S antigen level, using a general-purpose automated analyzer, allowing protein S-specific activity (ratio of total protein S activity to total protein S antigen level) to be calculated. Mean specific activity was 0.99 for samples from healthy individuals but 0.69 or less (mean-3SD) in protein S type II-deficient and warfarin-treated samples, but was 1.0 in an estrogen-treated sample with significantly decreased protein S antigen. Protein S gene analyses in healthy individuals with specific activity 0.69 or less revealed the K155E mutation in all three. These results show our new assay system to be an effective screening tool for protein S type II deficiency. This system can also be used in an automated analyzer, facilitating numerous sample measurements, and is, thus, applicable to regular medical checkups and diagnosing VTE. Such applications would potentially contribute to early detection of protein S type II deficiency, and, thereby, to thrombosis prevention.
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7
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Yokoyama K, Kojima T, Sakata Y, Kawasaki T, Tsuji H, Miyata T, Okamoto S, Murata M. A survey of the clinical course and management of Japanese patients deficient in natural anticoagulants. Clin Appl Thromb Hemost 2012; 18:506-13. [PMID: 22311628 DOI: 10.1177/1076029611435839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Few data are available on the clinical course of Japanese patients deficient in natural anticoagulants (antithrombin (AT), protein C, and protein S). We conducted a nationwide survey to reveal the clinical course of these patients. Questionnaires were sent to 321 council members of the Japanese Society on Thrombosis and Hemostasis, Japanese Society for Vascular Surgery, and Japanese Society of Phlebology. A total of 103 responses were obtained and data of 183 patients were collected. Of 183 patients, 142 (78%) experienced at least one episode of venous thromboembolism (VTE). The first VTE occurred before the age of 40 years in 71 patients (45%). Venous thromboembolism recurred in 15 (39%) patients with AT deficiency and 19 (18%) patients with other deficiencies. These findings suggest that half of the first episodes of VTE in patients deficient in natural anticoagulants occur before middle age and the risk of VTE recurrence is high in patients with AT deficiency.
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Affiliation(s)
- Kenji Yokoyama
- Division of Hematology, Department of Medicine, School of Medicine, Keio University, Tokyo, Japan.
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8
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Branco CC, Pereirinha T, Cabral R, Pacheco PR, Mota-Vieira L. Thrombotic genetic risk factors and warfarin pharmacogenetic variants in São Miguel's healthy population (Azores). Thromb J 2009; 7:9. [PMID: 19538716 PMCID: PMC2706804 DOI: 10.1186/1477-9560-7-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 06/18/2009] [Indexed: 11/26/2022] Open
Abstract
SUMMARY BACKGROUND The Azorean population presents the highest standardized mortality rate for cardiovascular diseases (CVD) when compared to mainland Portugal and other populations. Since thrombosis is a common cause of CVD, we assessed four polymorphisms in three thrombotic risk genes - F5 (G1691A), F2 (G20210A) and MTHFR (C677T, A1298C), in 469 healthy blood donors from São Miguel Island (Azores). We also analysed the CYP2C9 (C430T, A1075C) and VKORC1 (G1639A) variants in fifty-eight individuals with predisposition to thrombosis (possessing at least one variation in F5 or F2 genes and one in MTHFR) to evaluate their warfarin drug response genetic profiles. RESULTS Among the 469 individuals, the data showed that thrombotic risk allele frequencies - 1691A (4.9%), 20210A (1.8%), 677T (41.7%) and 1298C (24.8%) - were similar to other Caucasians, but significantly different from mainland Portuguese (chi2, p < 0.001). The combined analysis of these variants identified twenty-two different genetic profiles (genotype order: F5, F2, MTHFR C677T and A1298C). Complete homozygosity for all wild-type alleles (GG GG CC AA) was present in 11.7%, being GG GG CT AA (22.4%) the most frequent profile. The results also demonstrated that 12.4% (58 out of 469) of São Miguel islanders have increased genetic predisposition to thrombosis. Subsequently, we evaluated these individuals for their warfarin response genetic profiles. The data showed that seven out of fifty-eight individuals are poor metabolizers (two with CYP2C9*2/*2 and five with CYP2C9*2/*3 genotypes). VKORC1 polymorphism analysis identified twelve individuals (20.7%) with AA genotype, who probably will require lower doses of warfarin. The joint analysis of CYP2C9 and VKORC1 revealed that 79.3% (46 out of 58) of the individuals carry at least one polymorphism in these genes. Within these, twenty-five individuals (43.1%) need intermediate and/or low doses of warfarin, if treatment is started. CONCLUSION The present study demonstrated, for the first time, that São Miguel, and possibly the Azores population, shows significant differences on allele frequencies of thrombotic risk factors when compared to mainland Portugal. This research constitutes a primary approach for future studies on CVD, as well as for the implementation of warfarin dosing protocols using the patient's genotypic information.
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Affiliation(s)
- Claudia C Branco
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tânia Pereirinha
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
| | - Rita Cabral
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Paula R Pacheco
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Luisa Mota-Vieira
- Molecular Genetics and Pathology Unit, Hospital of Divino Espirito Santo of Ponta Delgada, EPE, São Miguel Island, Azores, Portugal
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
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Jun J, Guan Z, Zhuo Z, Housshan LV. Correlation between single nucleotide polymorphism of prothrombin gene G20210 and deep vein thrombosis after total joint replacement in Chinese patients. ARTIFICIAL CELLS, BLOOD SUBSTITUTES, AND IMMOBILIZATION BIOTECHNOLOGY 2009; 37:177-82. [PMID: 19526440 DOI: 10.1080/10731190903040875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECT To evaluate the correlation between prothrombin gene G20210A mutation and deep vein thrombosis after total joint replacement through detecting distribution frequency of single nucleotide polymorphism of the gene in patients undergoing total joint replacement. METHOD PCR and direct sequencing of DNA are used to analyze the frequency of prothrombin gene G20210A mutation in 55 patients undergoing total joint replacement, and the relationship between the mutation and deep vein thrombosis after total joint replacement is evaluated. RESULT Morbidity of prothrombin gene G20210A mutation in 55 patients is 0, both in the DVT group and non-DVT group. There is no significant difference between the two groups (p > 0.05). CONCLUSION Mutation of prothrombin gene G20210A in Chinese patients is rare, and there is no correlation between the genetic mutation and deep vein thrombosis after total joint replacement.
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Affiliation(s)
- Jiang Jun
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
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10
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Prevalence of the prothrombin G20210A polymorphism in the Lebanese population: use of a reverse hybridization strip assay approach. Mol Biol Rep 2007; 36:399-403. [DOI: 10.1007/s11033-007-9193-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 11/26/2007] [Indexed: 11/29/2022]
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Nagaraja D, Kruthika-Vinod TP, Christopher R. The prothrombin gene G20210A variant and puerperal cerebral venous and sinus thrombosis in South Indian women. J Clin Neurosci 2007; 14:635-8. [PMID: 17433691 DOI: 10.1016/j.jocn.2006.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 05/01/2006] [Accepted: 05/02/2006] [Indexed: 10/23/2022]
Abstract
Pregnancy and puerperium raise the risk of thrombotic events, and these risks are likely to be increased in women who are carriers of thrombophilic gene polymorphisms. Prothrombin G20210A variant is reported to be the second most frequent prothrombotic polymorphism in Caucasians. Our aim was to determine the prevalence of this variant in south Indian women and examine its association with cerebral venous and sinus thrombosis occurring during puerperium. We investigated 96 women with puerperal cerebral veno-sinus thrombosis (CVT) and 103 age-matched women with no post-partum complications. We used restriction fragment length polymorphism analysis to identify their genotypes. The prothrombin G20210A variant was not detected in either the CVT patients or the healthy control subjects. Our study on a large series of patients with puerperal CVT shows that the prothrombin G20210A variant is not present in south Indian women and is not associated with puerperal CVT. This study also highlights the fact that there are racial differences in the risk factors for thrombosis, which should be considered when investigating these patients.
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Affiliation(s)
- Dindagur Nagaraja
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Post box 2900, Hosur Road, Bangalore 560029, Karnataka, India.
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Abstract
Recently, a single mutation in the 3'-untranslated region of the prothrombin gene was reported, resulting in a G-to-A substitution. This finding added to the growing list of genetic disorders thought to be responsible for familial thrombophilia. Although most studies generally agree about the increased risk of venous thrombosis in individuals carrying this mutation, its role in the first event of venous thromboembolism and in recurrent events is unclear. Even less clear is the role this mutation has in the formation of arterial thrombosis (including coronary artery disease and cerebral ischemia) due to contradicting results of studies. This mutation has important clinical implications since it is a common cause of genetic thrombophilia, second only to the factor V Leiden mutation. However, the mutation by itself may not be enough to trigger disease because thromboembolic disease is now generally accepted as a multifactorial disorder. Careful evaluation of this mutation will augment the clinician's ability to stratify systematically an individual's risk of developing spontaneous thrombosis.
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Affiliation(s)
- A Nguyen
- Department of Internal Medicine, University of Texas, Southwestern Medical School, Dallas 75235, USA
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13
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Fujimura H, Kawasaki T, Sakata T, Ariyoshi H, Kato H, Monden M, Miyata T. Common C677T polymorphism in the methylenetetrahydrofolate reductase gene increases the risk for deep vein thrombosis in patients with predisposition of thrombophilia. Thromb Res 2000; 98:1-8. [PMID: 10706928 DOI: 10.1016/s0049-3848(99)00231-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The alanine/valine (A/V) gene polymorphism of 5, 10-methylenetetrahydrofolate reductase (MTHFR), one of the key enzymes catalyzing remethylation of homocysteine, has been reported and the VV genotype is associated with increased plasma homocysteine levels as a result of the reduced activity and increased thermolability of this enzyme. Although previous studies have suggested that the VV genotype is a risk factor for arterial occlusive disease, whether the VV genotype is a risk factor for venous thrombosis is still controversial. Here we screened 72 Japanese patients with deep venous thrombosis (DVT) and 85 controls for this mutation, and we measured plasma levels of homocysteine to determine whether the thermolabile variant with the VV genotype is a risk factor for DVT in a Japanese population. Of the 72 patients with DVT, 10 (13.9%) were found to be homozygous for the VV genotype, and in 6 (7.0%) of 85, control individuals and the difference was not significant (odds ratio=2.12, 95% CI=0.73-6.16, p=0.19). When we divided the DVT patients into subgroups, with and without predisposition of thrombophilia, including deficiencies of proteins C and S, plasminogen, and lupus anticoagulant, the prevalence of the VV genotype in DVT patients with predisposition was significantly higher than that of the normal controls (odds ratio=5.99, 95% CI=1. 56-22.96, p=0.01). However, the prevalence of the VV genotype in DVT patients without predisposition was not significantly different from that of the normal controls (odds ratio=1.20, 95% CI=0.32-4.47, p=0. 75). The plasma homocysteine levels in patients with DVT (11.6+/-5.2 nmol/ml) was not significantly different from that of the control subjects (11.6+/-3.7 nmol/ml). Individuals with the VV genotype showed higher plasma homocysteine levels (15.4+/-6.9 nmol/ml) than did individuals with the AV genotype (11.2+/-3.7 nmol/ml, p=0.009) or in individuals with the AA genotype (11.1+/-4.2 nmol/ml, p=0.004). Serum folate and vitamin B12 levels were not correlated with the plasma homocysteine levels. In conclusion, even though homozygosity for the VV genotype of the MTHFR gene was associated with higher plasma homocysteine levels, we found no association between plasma levels of homocysteine and DVT or between the genotype of the MTHFR gene and the DVT incidence. However, we found that the VV genotype of the MTHFR gene is a risk factor for DVT only when combined with the predisposition of thrombophilia.
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Affiliation(s)
- H Fujimura
- Department of Surgery II, Osaka University Medical School, Suita, Japan
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14
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Genetic polymorphisms associated with thrombotic disorders in the Japanese population. ACTA ACUST UNITED AC 2000. [DOI: 10.1054/fipr.2000.0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Girolami A, Simioni P, Scarano L, Carraro G. Prothrombin and the prothrombin 20210 G to A polymorphism: their relationship with hypercoagulability and thrombosis. Blood Rev 1999; 13:205-10. [PMID: 10741896 DOI: 10.1054/blre.1999.0117] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Polymorphisms of several clotting factors have been associated during the past few years with an increased risk of both venous or arterial thrombosis. However, final proof for the existence of a pathogenetic relationship between a given polymorphism and an increased risk for thrombosis is still lacking. Particular emphasis has been placed recently on a 20210 G to A prothrombin polymorphism. A critical review of available data indicates that such an abnormality may be associated with an increased risk of venous thrombosis but not arterial thrombosis (with a possible exception for myocardial infarction). However, this conclusion is based only on retrospective cohort studies which compared the prevalence of the abnormality in a group of patients with past venous or arterial thrombosis with a normal group (with no thrombosis). No prospective study has yet to show that patients with the abnormality, given similar additional acquired risk factors, have a higher incidence of thrombotic complications as compared with controls. The mechanism whereby the abnormality might cause thrombosis has been assumed to be an increase in prothrombin levels. Since an association between two phenomena does not necessarily mean that a causal relationship exists between the same events, it is important to be cautious before claiming that such abnormality is responsible for thrombosis. Therefore, although included commonly in the investigation profile, the search for the 20210 G to A prothrombin abnormality should not be considered yet to be an essential component in the routine study of hypercoagulable and/or thrombotic conditions.
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Affiliation(s)
- A Girolami
- University of Padua Medical School, Department of Medical and Surgical Sciences, Italy.
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A Single Genetic Origin for the Common Prothrombotic G20210A Polymorphism in the Prothrombin Gene. Blood 1998. [DOI: 10.1182/blood.v92.4.1119.416k39_1119_1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The polymorphism G20210A in the 3′ untranslated region of the prothrombin gene is associated with an increased level of factor II activity and confers a twofold to fivefold increase in the risk for venous thromboembolism. Among Caucasian populations, the prevalence of factor II G20210A heterozygotes is 1% to 6%, whereas in non-Caucasian populations it is very rare or absent. The aim of the present study was to discern whether factor II G20210A originated from a single or recurrent mutational events. Allele frequencies of four dimorphisms spanning 16 of 21 kb of the factor II gene were determined in 133 unrelated Caucasian subjects of Jewish, Austrian, and French origins who bore factor II G20210A (10 homozygotes and 123 heterozygotes) and 110 Caucasian controls. Remarkable differences in the allele frequencies for each dimorphism were observed between the study groups (P = .0007 or less), indicating strong linkage disequilibrium and suggesting a founder effect. Indeed, a founder haplotype was present in 68% of 20210A mutant alleles and only in 34% of 20210G normal alleles (P < .0001). These data strongly support a single origin for factor II G20210A that probably occurred after the divergence of Africans from non-Africans and of Caucasoid from Mongoloid subpopulations.© 1998 by The American Society of Hematology.
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A Single Genetic Origin for the Common Prothrombotic G20210A Polymorphism in the Prothrombin Gene. Blood 1998. [DOI: 10.1182/blood.v92.4.1119] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe polymorphism G20210A in the 3′ untranslated region of the prothrombin gene is associated with an increased level of factor II activity and confers a twofold to fivefold increase in the risk for venous thromboembolism. Among Caucasian populations, the prevalence of factor II G20210A heterozygotes is 1% to 6%, whereas in non-Caucasian populations it is very rare or absent. The aim of the present study was to discern whether factor II G20210A originated from a single or recurrent mutational events. Allele frequencies of four dimorphisms spanning 16 of 21 kb of the factor II gene were determined in 133 unrelated Caucasian subjects of Jewish, Austrian, and French origins who bore factor II G20210A (10 homozygotes and 123 heterozygotes) and 110 Caucasian controls. Remarkable differences in the allele frequencies for each dimorphism were observed between the study groups (P = .0007 or less), indicating strong linkage disequilibrium and suggesting a founder effect. Indeed, a founder haplotype was present in 68% of 20210A mutant alleles and only in 34% of 20210G normal alleles (P < .0001). These data strongly support a single origin for factor II G20210A that probably occurred after the divergence of Africans from non-Africans and of Caucasoid from Mongoloid subpopulations.© 1998 by The American Society of Hematology.
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