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Zhang Y, Zeng J, Bao S, Zhang B, Li X, Wang H, Cheng Y, Zhang H, Zu L, Xu X, Xu S, Song Z. Cancer progression and tumor hypercoagulability: a platelet perspective. J Thromb Thrombolysis 2024:10.1007/s11239-024-02993-0. [PMID: 38760535 DOI: 10.1007/s11239-024-02993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
Venous thromboembolism, which is common in cancer patients and accompanies or even precedes malignant tumors, is known as cancer-related thrombosis and is an important cause of cancer- associated death. At present, the exact etiology of the elevated incidence of venous thrombosis in cancer patients remains elusive. Platelets play a crucial role in blood coagulation, which is intimately linked to the development of arterial thrombosis. Additionally, platelets contribute to tumor progression and facilitate immune evasion by tumors. Tumor cells can interact with the coagulation system through various mechanisms, such as producing hemostatic proteins, activating platelets, and directly adhering to normal cells. The relationship between platelets and malignant tumors is also significant. In this review article, we will explore these connections.
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Affiliation(s)
- Yifan Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingtong Zeng
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shihao Bao
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianjie Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hanqing Wang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Cheng
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lingling Zu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaohong Xu
- Colleges of Nursing, Tianjin Medical University, Tianjin, China
| | - Song Xu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.
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Thrombophilia and outcomes of venous thromboembolism in older patients. Res Pract Thromb Haemost 2022; 7:100015. [PMID: 36970742 PMCID: PMC10031374 DOI: 10.1016/j.rpth.2022.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023] Open
Abstract
Background Limited data exist on thrombophilic risk factors and clinical outcomes in the elderly with venous thromboembolism (VTE). Objectives To describe the prevalence of laboratory thrombophilic risk factors and their association with VTE recurrence or death in a cohort of elderly people with VTE. Methods In 240 patients aged ≥65 years with acute VTE without active cancer or an indication for extended anticoagulation, we performed laboratory thrombophilia testing 1 year after the index VTE. Recurrence or death was assessed during the 2-year follow-up. Results A total of 78% of patients had ≥1 laboratory thrombophilic risk factor(s). Elevated levels of von Willebrand factor, homocysteine, coagulant activity of factor VIII (FVIII:C), fibrinogen, FIX:C, and low antithrombin activity were the most prevalent risk factors (43%, 30%, 15%, 14%, 13%, and 11%, respectively). Additionally, 16.2% of patients experienced VTE recurrence and 5.8% of patients died. Patients with a von Willebrand factor of >182%, FVIII:C level >200%, homocysteine level >15μmol/L, or lupus anticoagulant had a significantly higher rate of recurrence than those without these risk factors (15.0 vs. 6.1 [P = .006], 23.5 vs. 8.2 [P = .01], 17.0 vs. 6.8 [P = .006], and 89.5 vs. 9.2 [P = .02] events per 100 patient-years, respectively). Furthermore, patients with a high fibrinogen level or hyperhomocysteinemia with a homocysteine level ≥30 μmol/L had significantly higher mortality than patients with normal levels (18.5 vs. 2.8 [P = .049] and 13.6 vs. 2 [P = .002] deaths per 100 patient-years, respectively). After adjustments for relevant confounders, these associations remained unchanged. Conclusion Laboratory thrombophilic risk factors are common in elderly people with VTE and allow for the identification of a population at the risk of worse clinical outcomes.
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Posch-Pertl L, List W, Michelitsch M, Pinter-Hausberger S, Posch F, Innauer F, Renner W, Weger M. Role of the ABO Blood Groups as a Risk Factor for Retinal Vein Occlusion. Ophthalmic Res 2022; 66:164-169. [PMID: 36049476 DOI: 10.1159/000526874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/15/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A recent study suggested that non-O blood groups had an increased risk for the presence of retinal vein occlusion (RVO). In this study, we investigated (i) an association between blood group and the presence of RVO and (ii) whether this association correlated to other RVO risk factors. METHODS We included 485 RVO patients and 295 control subjects who were recruited in this case-control study. We determined ABO genotypes rs8176719 as a marker for the O allele and rs8176746 for the B allele by polymerase chain reaction. RESULTS We did not find an association between ABO blood group and the presence of RVO. In detail, the proportion of ABO blood groups was similar among RVO patients and control subjects (p = 0.527). In a logistic regression, non-O blood group was associated with 1.06-fold higher odds of being a RVO patient (95% CI: 0.78-1.45, p = 0.693), and this lack of association prevailed upon multivariable adjustment for age, gender, history of stroke and venous thromboembolism, and co-medication with lipid-lowering agents. DISCUSSION Although non-O blood groups are a known risk factor for thrombotic and cardiovascular disease, they do not seem to be a major risk factor for the development of RVO.
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Affiliation(s)
- Laura Posch-Pertl
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Wolfgang List
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Monja Michelitsch
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | | | - Florian Posch
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Innauer
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Wilfried Renner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Martin Weger
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
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Parmontree P, Ketprathum P, Ladnok T, Meeaium S, Thanaratsiriworakul T, Sonhorm U. Predictive risk factors for venous thromboembolism in neurosurgical patients: A retrospective analysis single center cohort study. Ann Med Surg (Lond) 2022; 77:103628. [PMID: 35638055 PMCID: PMC9142669 DOI: 10.1016/j.amsu.2022.103628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Venous thromboembolism (VTE) has a major effect on morbidity and mortality in neurosurgical patients. However, identifying risk factors that may be useful in practice is a challenge. The purpose of this study was to investigate the incidence and determine the predictors of VTE in patients undergoing neurosurgery. Materials and methods This retrospective, single-center cohort study was conducted on adult patients admitted to a private hospital for a primary elective neurosurgical procedure between January 2015 and December 2020. Univariate analysis was used to examine clinical factors, and multivariable regression analysis was used to identify predictors of VTE. The area under the receiver-operating characteristic (AUROC) curve demonstrated the fitting model and discrimination power. Results A total of 350 patients who underwent neurological surgery were identified. There were 26 patients (7.4%) with VTE. The final predictors were found to be statistically significant in the multivariate binary logistic regression analysis, including non-Asian populations (p value < 0.001, odds ratio [OR]: 6.11, 95% confidence interval [CI] = 2.20–16.89), lack of postoperative ambulation (p value = 0.009, OR: 9.25, 95% CI = 1.17–48.83), and septic shock complication (p value = 0.001, OR: 5.36, 95% CI = 1.46–19.62). The AUROC was 0.708 (95% CI 0.61–0.80). Conclusion Although the incidence of VTE in patients receiving neurosurgery is minimal, it is also higher in non-Asian patients, those who lack of postoperative ambulation, and patients with septic shock complications. This approach may be useful to predict thromboembolism in neurosurgical patients. External validation of the prognostic model requires more investigation. Venous thromboembolism (VTE) complications can be a major cause of morbidity and even death in neurosurgical patients. The standard therapy for the appropriate prophylaxis remains unclear. Whether or not to use pharmacological prophylaxis is determined by a higher-risk category of individuals. Based on information from risk factors, it may be a benefit guide for proper VTE prophylaxis.
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Affiliation(s)
- Porntip Parmontree
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
- Corresponding author. Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, 20131, Thailand.
| | | | - Teeraphat Ladnok
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Supanut Meeaium
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | | | - Ukrit Sonhorm
- Pharmacy Department, Bangkok Hospital Pattaya, Chonburi, Thailand
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Dick-Guareschi J, Fontana JC, Sanseverino MTV, Kubaski F, Sekine L, Mesquita NF, Onsten TGH, Leistner-Segal S. Prevalence of thrombophilia-associated genetic risk factors in blood donors of a regional hospital in southern Brazil. Hematol Transfus Cell Ther 2021; 44:379-385. [PMID: 33775585 PMCID: PMC9477773 DOI: 10.1016/j.htct.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/02/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Thromboembolic events occur due to an imbalance in the hemostasis and some factors associated with this condition can be inherited. In order to evaluate the frequency of genotypes considered to be common hereditary risk factors for thrombophilia associated with venous thrombosis (g.1691G > A and g.20210G > A) and hyperhomocysteinemia (g.677C > T and g.1298A > C), samples from voluntary healthy blood donors at the Hospital de Clínicas de Porto Alegre were tested. Methods We examined 325 blood samples from blood donors collected from October 2017 to July 2018. Blood was collected on filter paper and the DNA was extracted for single nucleotide polymorphisms (SNPs) analysis using the qualitative real time polymerase chain reaction. Results The calculated frequencies of each genetic variant in heterozygosity were 4% for the FV gene (g.1691G > A), 4% for the F2 gene (g.20210G > A) and 42% and 39% for methylenetetrahydrofolate reductase (MTHFR), g.677C > T and g.1298A > C, respectively. Only the genetic variants of MTHFR were found in homozygosity, with frequencies of 14% and 6% (g.677C > T and g.1298A > C), respectively. Discussion Altogether, these results describe the frequencies of genetic variants associated with venous thrombosis and hyperhomocysteinemia in the analyzed group and are important to enhance our current knowledge about the genetic profiles of Brazilian blood donors.
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Affiliation(s)
- Jéssica Dick-Guareschi
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | | | - Francyne Kubaski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Leo Sekine
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Tor Gunnar Hugo Onsten
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Sandra Leistner-Segal
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Wang H, Rosendaal FR, Cushman M, van Hylckama Vlieg A. Procoagulant factor levels and risk of venous thrombosis in the elderly. J Thromb Haemost 2021; 19:186-193. [PMID: 33090602 PMCID: PMC7839504 DOI: 10.1111/jth.15127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
Essentials Venous thrombosis (VT) risk and coagulation factor levels increase with age. We studied the association between levels of procoagulant factors and the risk of a first VT in the elderly. Higher levels of factors VIII, IX, and XI, but not prothrombin, were associated with the risk of VT. Similar risk patterns were observed for provoked and unprovoked VT and for deep vein thrombosis and pulmonary embolism separately. ABSTRACT: Background Venous thrombosis (VT) incidence increases markedly with age. Coagulation factors are also positively associated with age. Objective To study whether higher levels of coagulation factors II (prothrombin), VIII, IX, and XI are associated with risk of a first VT in the elderly. Methods Four hundred and one patients and 431 control subjects aged 70 and older were included in the Age and Thrombosis, Acquired and Genetic risk factors in the Elderly (AT-AGE) study. Blood was collected 1 year after the event in patients and in all control subjects for measurement of coagulation factors. To assess the risk of VT, odds ratios (ORs) were calculated after stratification of coagulation factors in quartiles and at the 90th percentile, adjusting for potential confounders (age, sex, body mass index, and study center). Results Mean age was 78 years (range: 70-100 years). The ORs of VT for factors in the top quartile compared with the lowest quartile were 4.5 (95% confidence interval [CI]:2.7-7.3) for factor VIII, 2.4 (95% CI:1.1-5.2) for factor IX, and 1.7 (95% CI:1.0-2.9) for factor XI. High prothrombin was not associated with an increased VT risk. There was no dose-response association between the number of high coagulation factors and VT risk. The population attributable risk (PAR) of VT was 37.6%, 23.3%, and 12.4% for factor VIII, IX, and XI, respectively. Conclusion In this study of the elderly, higher factors VIII, IX, and XI but not prothrombin, were positively associated with the risk of VT.
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Affiliation(s)
- Huijie Wang
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Mary Cushman
- Department of MedicineLarner College of Medicine at the University of VermontBurlingtonVTUSA
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Oxidative Stress and Thrombosis during Aging: The Roles of Oxidative Stress in RBCs in Venous Thrombosis. Int J Mol Sci 2020; 21:ijms21124259. [PMID: 32549393 PMCID: PMC7352981 DOI: 10.3390/ijms21124259] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/17/2023] Open
Abstract
Mid-life stage adults are at higher risk of developing venous thrombosis (VT)/thromboembolism (VT/E). Aging is characterized by an overproduction of reactive oxygen species (ROS), which could evoke a series of physiological changes involved in thrombosis. Here, we focus on the critical role of ROS within the red blood cell (RBC) in initiating venous thrombosis during aging. Growing evidence has shifted our interest in the role of unjustifiably unvalued RBCs in blood coagulation. RBCs can be a major source of oxidative stress during aging, since RBC redox homeostasis is generally compromised due to the discrepancy between prooxidants and antioxidants. As a result, ROS accumulate within the RBC due to the constant endogenous hemoglobin (Hb) autoxidation and NADPH oxidase activation, and the uptake of extracellular ROS released by other cells in the circulation. The elevated RBC ROS level affects the RBC membrane structure and function, causing loss of membrane integrity, and decreased deformability. These changes impair RBC function in hemostasis and thrombosis, favoring a hypercoagulable state through enhanced RBC aggregation, RBC binding to endothelial cells affecting nitric oxide availability, RBC-induced platelet activation consequently modulating their activity, RBC interaction with and activation of coagulation factors, increased RBC phosphatidylserine exposure and release of microvesicles, accelerated aging and hemolysis. Thus, RBC oxidative stress during aging typifies an ultimate mechanism in system failure, which can affect major processes involved in the development of venous thrombosis in a variety of ways. The reevaluated concept of the critical role of RBC ROS in the activation of thrombotic events during aging will help identify potential targets for novel strategies to prevent/reduce the risk for VT/E or VT/E recurrences in mid-life stage adults.
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Stowell SR, Stowell CP. Biologic roles of the ABH and Lewis histo-blood group antigens part II: thrombosis, cardiovascular disease and metabolism. Vox Sang 2019; 114:535-552. [PMID: 31090093 DOI: 10.1111/vox.12786] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
The ABH and Lewis antigens were among the first of the human red blood cell polymorphisms to be identified and, in the case of the former, play a dominant role in transfusion and transplantation. But these two therapies are largely twentieth-century innovations, and the ABH and related carbohydrate antigens are not only expressed on a very wide range of human tissues, but were present in primates long before modern humans evolved. Although we have learned a great deal about the biochemistry and genetics of these structures, the biological roles that they play in human health and disease are incompletely understood. This review and its companion, which appeared in a previous issue of Vox Sanguinis, will focus on a few of the biologic and pathologic processes which appear to be affected by histo-blood group phenotype. The first of the two reviews explored the interactions of two bacteria with the ABH and Lewis glycoconjugates of their human host cells, and described the possible connections between the immune response of the human host to infection and the development of the AB-isoagglutinins. This second review will describe the relationship between ABO phenotype and thromboembolic disease, cardiovascular disease states, and general metabolism.
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Affiliation(s)
- Sean R Stowell
- Center for Apheresis, Center for Transfusion and Cellular Therapies, Emory Hospital, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher P Stowell
- Blood Transfusion Service, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
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Tana C, Lauretani F, Ticinesi A, Prati B, Nouvenne A, Meschi T. Molecular and Clinical Issues about the Risk of Venous Thromboembolism in Older Patients: A Focus on Parkinson's Disease and Parkinsonism. Int J Mol Sci 2018; 19:ijms19051299. [PMID: 29701703 PMCID: PMC5983741 DOI: 10.3390/ijms19051299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 01/06/2023] Open
Abstract
Venous thromboembolism (VTE) is a common and potentially life-threatening condition which includes both deep-vein thrombosis (DVT) and pulmonary embolism (PE). VTE has a significant clinical and epidemiological impact in the elderly, and its incidence increases to more than 1% per year in older patients, suggesting the presence of specific age-related risk factors in this population. Immobilization seems to predominate as the main cause in patients admitted for medical acute illness in medicine wards, and there is evidence of a high risk in older patients with immobilization resulting from advanced forms of Parkinson’s disease (PD), regardless of the presence of an acute medical condition. In this review, we would to discuss the recent evidence on clinical, molecular and epidemiological features of VTE in older frail subjects focusing on patients with PD and parkinsonism. We also discuss some therapeutic issues about the risk prevention and we suggest a thorough comprehensive geriatric assessment that can represent an optimal strategy to identify and prevent the VTE risk in these patients.
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
| | - Fulvio Lauretani
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
- Department of Medicine and Surgery, University-Hospital of Parma, 43126 Parma, Italy.
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University-Hospital of Parma, 43126 Parma, Italy.
| | - Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
- Department of Medicine and Surgery, University-Hospital of Parma, 43126 Parma, Italy.
| | - Beatrice Prati
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatric-Rehabilitation Department, University-Hospital of Parma, 43126 Parma, Italy.
- Department of Medicine and Surgery, University-Hospital of Parma, 43126 Parma, Italy.
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University-Hospital of Parma, 43126 Parma, Italy.
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Tomic BV, Gvozdenov MZ, Pruner IB, Simic JM, Kovac MK, Radojkovic DP, Djordjevic VJ. Are Prothrombotic Mutations a Time-to-Event Risk Factor? Lab Med 2017; 48:326-331. [PMID: 29036518 DOI: 10.1093/labmed/lmx046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Deep vein thrombosis (DVT) represents a common disorder involving genetic and acquired risk factors. It has been proposed that acquired risk factors are more important with aging than genetic factors, indicating different prevalence of prothrombotic mutations throughout the lifespan. Objective To determine the role of the most frequent prothrombotic genetic risk factors (Factor V [FV] Leiden and Factor II [FII] G20210A mutations) in first-time DVT etiology in patients of different ages. Method This retrospective study included 701 patients living in Serbia with diagnosed DVT as a first-time thrombotic event. Results Risk assessment for mutations as age-related markers showed no statistical difference (FV Leiden mutation-OR, 1.027; 95% confidence interval [CI], .87-1.22; P = .76 and FII G20210A mutation-OR, 0.940, 95% CI, .74-1.19; P = .61). Our results show similar mutation prevalence regardless of how old the patients were at the time of the first DVT occurrence. Conclusion Our results indicate that these 2 mutations cannot be used as prognostic marker for time-to-event first DVT in the Serbian population; however, further studies are required.
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Affiliation(s)
- Branko V Tomic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Maja Z Gvozdenov
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Iva B Pruner
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Jelena M Simic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Mirjana K Kovac
- Faculty of Medicine, University of Belgrade, Serbia.,Blood Transfusion Institute of Serbia, Hemostasis Department, Belgrade, Serbia
| | - Dragica P Radojkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Valentina J Djordjevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
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Shakeel M, Thachil J. Dilemmas in the management of venous thromboembolism in older patients. Br J Hosp Med (Lond) 2017; 78:552-557. [PMID: 29019726 DOI: 10.12968/hmed.2017.78.10.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Venous thromboembolism most commonly affects older patients. Despite the high incidence in this population, challenges remain in terms of the understanding of its presentation, diagnosis and management. Old age is associated with multi-morbidities which may complicate the diagnosis of venous thromboembolism as signs or symptoms may be attributed to underlying medical conditions. The presence of certain comorbidities (such as congestive cardiac failure and chronic obstructive pulmonary disease) also increases the risk of venous thromboembolism, but could mimic the clinical features of pulmonary embolism. In addition, the physiological processes associated with ageing and factors such as immobility and malignancy, which are more common in older people, will further increase the thrombotic risk. Dilemmas also exist with treatment decisions because of the concomitant increased risk of bleeding, comorbidities, polypharmacy, frailty and the risk of falls.
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Affiliation(s)
- Musfira Shakeel
- Medical Student, University of Manchester, Manchester M13 9WL
| | - Jecko Thachil
- Consultant Haematologist, Department of Haematology, Manchester Royal Infirmary, Manchester
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