Departement of Haematology, Oslo University Hospital, Oslo, Norway.
Thromb Haemost. 2012 Dec;108(6):1165-71. doi: 10.1160/TH12-05-0350. Epub 2012 Sep 26.
Limited data exist on thrombophilia and the risk of venous thrombosis (VT) during pregnancy and postpartum. The objectives of the present study were to investigate the role of haemostatic risk factors for pregnancy-related VT and their phenotypic expression in deep-vein thrombosis (DVT) and pulmonary embolism (PE). Total 313 cases with objectively verified first time VT and 353 controls were selected from a source population of 377,155 women with 613,232 pregnancies. The adjusted odds ratio (aOR) for pregnancy-related VT was 1.7 (95% confidence interval [CI] 1.1-2.8) for women with factor VIII >90th percentile. The aOR for VT for endogenous thrombin potential and D-dimer values >90th percentiles were 1.8 (95% CI 1.1-3.0) and 2.1 (95% CI 1.3-3.3), respectively. Factor IX >90th percentile or free protein S ≤the 5th percentile increased the risk for PE, and the aORs were 2.4 (95% CI 1.1-5.0) and 3.1 (95% CI 1.3-7.2), respectively. Women carrying the factor V Leiden (F5 rs6025) polymorphism, or who had reduced sensitivity to activated protein C (aPC) in the absence of F5 rs6025, had increased risk for DVT, with unadjusted ORs 7.7 (95% CI 4.7-12.7) and 3.5 (95% CI 2.2-5.4), respectively. Women with a history of pregnancy-related VT showed activation of coagulation and had elevated factor VIII. Furthermore, high levels of factor IX and low levels of free protein S were associated with increased risk for PE, whereas aPC resistance and F5 rs6025 were risk factors for DVT and not PE.
关于血栓形成倾向和妊娠及产后静脉血栓形成（VT）风险，目前的数据有限。本研究的目的是探讨与妊娠相关 VT 的止血风险因素及其在深静脉血栓形成（DVT）和肺栓塞（PE）中的表型表达。从 377155 名女性 613232 次妊娠的源人群中，选择了 313 例经客观证实的首发 VT 患者和 353 例对照。因子 VIII>第 90 百分位数的女性发生妊娠相关 VT 的调整比值比（aOR）为 1.7（95%置信区间[CI]1.1-2.8）。内源性凝血酶潜能和 D-二聚体值>第 90 百分位数的 VT 的 aOR 分别为 1.8（95%CI1.1-3.0）和 2.1（95%CI1.3-3.3）。因子 IX>第 90 百分位数或游离蛋白 S≤第 5 百分位增加了 PE 的风险，aOR 分别为 2.4（95%CI1.1-5.0）和 3.1（95%CI1.3-7.2）。携带因子 V Leiden（F5 rs6025）突变或缺乏 F5 rs6025 时对活化蛋白 C（aPC）敏感性降低的女性，DVT 的风险增加，未调整的 OR 分别为 7.7（95%CI4.7-12.7）和 3.5（95%CI2.2-5.4）。有妊娠相关 VT 病史的女性表现出凝血的激活，并且因子 VIII 升高。此外，因子 IX 水平升高和游离蛋白 S 水平降低与 PE 风险增加相关，而 aPC 抵抗和 F5 rs6025 是 DVT 的危险因素，而不是 PE。
