Weingarz Lea, Schindewolf Marc, Schwonberg Jan, Hecking Carola, Wolf Zsuzsanna, Erbe Matthias, Lindhoff-Last Edelgard, Linnemann Birgit
1 Division of Vascular Medicine and Haemostaseology, Goethe University Hospital, Frankfurt/Main, Germany.
Vasa. 2015 Jul;44(4):313-23. doi: 10.1024/0301-1526/a000447.
Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient's age at the time of the first VTE.
Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy.
Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years.
Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.
对于首次发生静脉血栓栓塞症（VTE）的患者，筛查血栓形成倾向是否有用是一个有争议的问题。然而，血栓形成倾向对复发风险的影响可能因首次VTE发作时患者的年龄而异。
在MAISTHRO（主要-伊萨尔-血栓形成）登记处登记的1221例VTE患者（42%为男性）中，261例在抗凝治疗中断后的5年随访期间发生了VTE复发。
VTE复发患者中血栓形成倾向比未复发患者更常见（58.6%对50.3%；p = 0.017）。按初次VTE发作时的年龄对患者进行分层，经年龄、性别以及是否存在既定危险因素调整后的Cox比例风险分析显示，杂合型凝血酶原（PT）G20210A突变（风险比（HR）2.65；95%置信区间（CI）1.71 - 4.12；p < 0.001）、因子V莱顿和/或PT突变的纯合子/双重杂合子（HR 2.35；95% CI 1.09 - 5.07，p = 0.030）以及抗凝血酶缺乏（HR 2.12；95% CI 1.12 - 4.10；p = 0.021）可预测40岁及以上患者的VTE复发，而狼疮抗凝物（HR 3.05；95% CI 1.40 - 6.66；p = 0.005）会增加年轻患者的复发风险。亚组分析显示，仅在未接受激素治疗的年轻女性中，杂合型因子V莱顿突变会增加复发风险，而杂合型PT突变的预测价值仅限于40岁以上的男性。
我们的数据不支持在首次静脉血栓栓塞事件后，对年轻患者进行血栓形成倾向检测的偏好。
