Hirmerova Jana, Seidlerova Jitka, Subrt Ivan, Slechtova Jitka
Second Department of Internal Medicine, Charles University Medical Faculty in Pilsen, Pilsen, Czech Republic -
Biomedical Centre, Charles University Medical Faculty in Pilsen, Pilsen, Czech Republic -
Int Angiol. 2017 Apr;36(2):167-173. doi: 10.23736/S0392-9590.16.03679-8. Epub 2016 Apr 14.
After the first episode of venous thromboembolism (VTE), the guidelines recommend selective thrombophilia testing and suggest not to test the patients older than 40 years with a provoked event and all patients above 60.
We compared thrombophilia workup results in 544 patients, meeting or not meeting the selection criteria. Homozygous factor V Leiden or prothrombin gene mutation, natural anticoagulant deficiencies, antiphospholipid syndrome or combination of ≥2 disorders were considered a strong thrombophilia.
Thrombophilia was detected in 28.5% and strong thrombophilia in 6.6% of patients. In the subgroup aged 40-60 years, in men with unprovoked cases the prevalence of thrombophilia was 35.7% and that of strong thrombophilia 12.5%; in provoked cases it was 19.5% and 4.9%, respectively. In women aged 40-60 with unprovoked events, thrombophilia was found in 18.8%, in cases provoked solely by estrogens or pregnancy in 40.9%, and in those with another trigger in 9.1%. Comparing the patients above and under 60, thrombophilia was detected in 27.6% and 29.2%, respectively (P=0.67) and strong thrombophilia in 9.1% and 4.7%, respectively (P=0.041). Factors significantly associated with positive thrombophilia testing were family history of VTE (including superficial vein thrombosis) - OR 1.80; 95% CI 1.71-2.77 and proximal location of deep vein thrombosis - OR 1.94; 95% CI 1.25-3.02.
Of VTE patients not meeting selection criteria for testing, the prevalence of thrombophilia and even strong thrombophilia was high in those older than 60 years. Selection criteria for testing should be respected but in some cases an individual approach might be considered.
在首次发生静脉血栓栓塞症（VTE）后，指南推荐进行选择性血栓形成倾向检测，并建议对于年龄超过40岁且有诱发因素的患者以及所有60岁以上的患者不进行检测。
我们比较了544例符合或不符合选择标准的患者的血栓形成倾向检查结果。纯合子因子V莱顿或凝血酶原基因突变、天然抗凝物质缺乏、抗磷脂综合征或≥2种疾病的组合被视为强烈的血栓形成倾向。
28.5%的患者检测到血栓形成倾向，6.6%的患者检测到强烈的血栓形成倾向。在40 - 60岁的亚组中，无诱因男性患者血栓形成倾向的患病率为35.7%，强烈血栓形成倾向的患病率为12.5%；有诱因的情况下，患病率分别为19.5%和4.9%。在40 - 60岁无诱因事件的女性中，18.8%发现有血栓形成倾向，仅由雌激素或妊娠诱发的病例中为40.9%，有其他诱因的病例中为9.1%。比较60岁以上和60岁以下的患者，血栓形成倾向的检出率分别为27.6%和29.2%（P = 0.67），强烈血栓形成倾向的检出率分别为9.1%和4.7%（P = 0.041）。与血栓形成倾向检测呈阳性显著相关的因素是VTE家族史（包括浅静脉血栓形成）——比值比1.80；95%置信区间1.71 - 2.77，以及深静脉血栓形成的近端位置——比值比1.94；95%置信区间1.25 - 3.02。
在不符合检测选择标准的VTE患者中，60岁以上患者的血栓形成倾向甚至强烈血栓形成倾向的患病率较高。应遵循检测的选择标准，但在某些情况下可考虑采用个体化方法。
