家族史在识别患有易栓症且口服避孕药期间发生静脉血栓栓塞风险较高的女性中的作用。

Role of family history in identifying women with thrombophilia and higher risk of venous thromboembolism during oral contraception.

作者信息

Cosmi Benilde, Legnani Cristina, Bernardi Francesco, Coccheri Sergio, Palareti Gualtiero

机构信息

Division of Angiology, Cardiovascular Department, Unità di Ricerca Clinica sulla Trombofilia Marino Golinelli, University Hospital S. Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.

出版信息

Arch Intern Med. 2003 May 12;163(9):1105-9. doi: 10.1001/archinte.163.9.1105.

DOI:10.1001/archinte.163.9.1105

PMID:12742811

Abstract

BACKGROUND

Unrecognized thrombophilic defects increase the risk of venous thromboembolism (VTE) in women during oral contraception (OC). We evaluated the sensitivity and specificity of a family history of VTE to identify thrombophilia in women before OC and after venous thrombotic complications during OC.

METHODS

Thrombophilia screening was performed after obtaining a family history by means of a standardized questionnaire in (1) thrombosis-free women before OC and (2) women after an episode of VTE during OC.

RESULTS

We evaluated 479 thrombosis-free women before OC (age range, 15-49 years); family history was positive in 49 (10.2%). Thrombophilic defects were identified in 36 participants (7.5%; 95% confidence interval [CI], 5%-10%), 3 of whom had a positive family history (8.3%). The sensitivity and positive predictive value of family history of thrombophilic defects were 8.3% (95% CI, 2%-22%) and 6.1% (95% CI, 1%-17%), respectively. We also evaluated 189 women after VTE complications during OC (age range, 15-49 years); family history was positive in 48 (25.4%; 95% CI, 19%-32%), 22 of whom had a thrombophilic defect (45.8%; 95% CI, 31%-61%). Thrombophilic defects were identified in 81 women (42.8%; 95% CI, 36%-50%). The sensitivity and positive predictive value of family history of thrombophilic defects were 27.2% (95% CI, 18%-38%) and 45.8% (95% CI, 31%-61%), respectively.

CONCLUSION

Family history of VTE has low sensitivity and positive predictive value for identifying women with thrombophilia who are more susceptible to VTE complications during OC.

摘要

背景

未被识别的血栓形成倾向缺陷会增加女性在口服避孕药（OC）期间发生静脉血栓栓塞（VTE）的风险。我们评估了VTE家族史在识别OC前女性以及OC期间发生静脉血栓并发症后女性的血栓形成倾向方面的敏感性和特异性。

方法

通过标准化问卷获取家族史后，对以下两类人群进行血栓形成倾向筛查：（1）OC前无血栓形成的女性；（2）OC期间发生一次VTE事件后的女性。

结果

我们评估了479名OC前无血栓形成的女性（年龄范围15 - 49岁）；家族史阳性的有49人（10.2%）。在36名参与者中发现了血栓形成倾向缺陷（7.5%；95%置信区间[CI]，5% - 10%），其中3人有阳性家族史（8.3%）。血栓形成倾向缺陷家族史的敏感性和阳性预测值分别为8.3%（95% CI，2% - 22%）和6.1%（95% CI，1% - 17%）。我们还评估了189名OC期间发生VTE并发症后的女性（年龄范围15 - 49岁）；家族史阳性的有48人（25.4%；95% CI，19% - 32%），其中22人有血栓形成倾向缺陷（45.8%；95% CI，31% - 61%）。在81名女性中发现了血栓形成倾向缺陷（42.8%；95% CI，36% - 50%）。血栓形成倾向缺陷家族史的敏感性和阳性预测值分别为27.2%（95% CI，18% - 38%）和45.8%（95% CI，31% - 61%）。