Department of Angiology Blood Coagulation Marino Golinelli, University Hospital S. Orsola-Malpighi, University of Bologna, Via Albertoni 15, Bologna, Italy.
Thromb Haemost. 2013 Mar;109(3):510-6. doi: 10.1160/TH12-01-0041. Epub 2013 Jan 10.
It was our aim to assess whether factor V Leiden (FVL) and G20210A prothrombin (FII) mutation are associated with the presence of residual vein obstruction (RVO) after a standard course of anticoagulation for a first episode of idiopathic proximal deep-vein thrombosis (DVT) of the lower limbs, with or without symptomatic pulmonary embolism (PE). Patients were enrolled in two prospective multicentre studies: PROLONG and PROLONG II. RVO was detected by compression ultrasonography according to the method of Prandoni on the day of anticoagulation withdrawal. Patients were also screened for FVL and FII mutation. The presence of FVL and/or FII mutation was determined in 872/963 (90.5%) patients, in 753 of whom RVO was assessed. FVL was significantly less frequent among subjects with isolated PE (7/176:4%) than among patients with either DVT and PE (15/133:11.3%; p=0.0018) or isolated DVT (89/563:15.8%; p<0.0001), confirming the FVL paradox. The rate of FII mutation was similar among patients with isolated PE (11/176:6.2%) and patients with either DVT and PE (12/133:9%) or isolated DVT (52/563:9.2%). FVL and FII mutation were not significantly associated with RVO at the multivariate analysis in all patients, although data suggest that FVL and FII mutation may have a differential effect on RVO in the subgroups of patients with DVT and DVT plus PE patients. Male sex and isolated DVT were significantly associated with RVO in all patients. In conclusion, male sex and isolated DVT are associated with RVO, while FVL and FII mutations are not significantly associated with RVO in this study.
我们的目的是评估因子 V 莱顿（FVL）和凝血酶原 G20210A（FII）突变是否与下肢特发性近端深静脉血栓形成（DVT）初次发作后标准抗凝疗程中残留静脉阻塞（RVO）的存在相关，包括有症状和无症状的肺栓塞（PE）。患者纳入了两项前瞻性多中心研究：PROLONG 和 PROLONG II。在抗凝治疗停止的当天，根据 Prandoni 方法，通过压迫超声检查来检测 RVO。同时还对患者进行了 FVL 和 FII 突变筛查。在 963 例患者中的 872 例（90.5%）患者中确定了 FVL 和/或 FII 突变的存在，其中 753 例评估了 RVO。在单纯 PE 患者中（176 例中的 7 例，4%），FVL 显著低于同时患有 DVT 和 PE（133 例中的 15 例，11.3%；p=0.0018）或单纯 DVT（563 例中的 89 例，15.8%；p<0.0001）患者，证实了 FVL 悖论。在单纯 PE 患者中（176 例中的 11 例，6.2%）和同时患有 DVT 和 PE（133 例中的 12 例，9%）或单纯 DVT（563 例中的 52 例，9.2%）患者中，FII 突变的发生率相似。在所有患者的多变量分析中，FVL 和 FII 突变与 RVO 无显著相关性，尽管数据表明，FVL 和 FII 突变可能对 DVT 和 DVT 加 PE 患者亚组的 RVO 有不同的影响。在所有患者中，男性和单纯 DVT 与 RVO 显著相关。总之，在本研究中，男性和单纯 DVT 与 RVO 相关，而 FVL 和 FII 突变与 RVO 无显著相关性。
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