Baba-Ahmed Mohamed, Le Gal Grégoire, Couturaud Francis, Lacut Karine, Oger Emmanuel, Leroyer Christophe
Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France.
Thromb Haemost. 2007 Feb;97(2):171-5.
Among candidate risk factors associated with postoperative venous thromboembolism (VTE), the role of factorV Leiden (FVL) mutation remains unclear. We performed a case-control study to assess the potential significance of FVL mutation in postoperative VTE cases despite prophylaxis. We used data from the ongoing case-control "EDITH" study. We extracted 133VTE cases and 144 controls who had undergone either surgery or had plaster cast in the previous three months. Prophylaxis adequacy with regard to the recommendations published by the American College of Chest Physicians was retrospectively assessed. FVL mutation was present in 20VTE cases and four controls (OR 5.9, 95% CI 2-18). Prophylaxis was judged as adequate in 116 cases (88.5%) and in 129 controls (87.2%) (p=0.66). The frequency of FVL mutation was not different in VTE cases occurring while on adequate prophylaxis and in VTE cases occurring after the end of adequate prophylaxis (p=0.27). FVL mutation was closely associated with postoperative VTE in patients classified as having received an adequate prophylaxis (8.4; 95% CI, 2.4 to 29). This study shows a close association between the presence of factorV Leiden mutation in symptomatic VTE occurring after surgery despite prophylaxis.
在与术后静脉血栓栓塞症(VTE)相关的候选风险因素中,凝血因子V莱顿(FVL)突变的作用仍不明确。我们进行了一项病例对照研究,以评估尽管采取了预防措施,但FVL突变在术后VTE病例中的潜在意义。我们使用了正在进行的病例对照“伊迪丝”研究的数据。我们提取了133例VTE病例和144例对照,这些病例和对照在过去三个月内接受了手术或打了石膏。回顾性评估了根据美国胸科医师学会发布的建议进行的预防措施是否充分。20例VTE病例和4例对照存在FVL突变(比值比5.9,95%置信区间2-18)。116例病例(88.5%)和129例对照(87.2%)的预防措施被判定为充分(p=0.66)。在预防措施充分时发生的VTE病例和预防措施充分结束后发生的VTE病例中,FVL突变的频率没有差异(p=0.27)。在被分类为接受了充分预防措施的患者中,FVL突变与术后VTE密切相关(8.4;95%置信区间,2.4至29)。这项研究表明,尽管采取了预防措施,但手术后出现症状性VTE时,凝血因子V莱顿突变的存在与之密切相关。