Obaid Munzir, El-Menyar Ayman, Asim Mohammad, Al-Thani Hassan
Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.
Department of Surgery, Clinical Research, Trauma and Vascular Surgery Section, HGH, Doha, Qatar.
Vasc Health Risk Manag. 2020 Mar 9;16:75-85. doi: 10.2147/VHRM.S241649. eCollection 2020.
We aimed to study the prevalence and outcomes of thrombophilia in acute pulmonary embolism.
A retrospective observational study was conducted to include patients with a radiologically confirmed diagnosis of PE screened for thrombophilia from May 2011 to February 2015. Data included patients' demographics; clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed and compared in patients with and without thrombophilia.
A total of 227 cases of PE were included in the study, of which 108 (47.6%) had thrombophilia. The most frequent coagulopathic abnormality included deficiency of protein S, protein C, and antithrombin III and hyperhomocysteinemia. Only seven out of 79 patients were found to have factor V Leiden. PE patients diagnosed with thrombophilia were 10 years younger in age and peaked in the age range 30-39 years. Prior history of DVT (=0.001) and PE (=0.001) were the main significant risk factors in the thrombophilia group. The frequency of different risk categories of clinical probability scores did not differ significantly among those with and without thrombophilia. Pulmonary hypertension was a common complication in the thrombophilia group (=0.009). Medications used included warfarin (74.7%), enoxaparin (73.9%), and heparin (55.4%). The overall mortality rate was 8.4%, and was non-significantly higher in the non-thrombophilia group.
Deficiencies of protein S, protein C, and antithrombin III are the leading causes of thrombophilic defects. Patients with hereditary thrombophilia are at increased risk of acute PE, particularly among young individuals. Therefore, early detection of thrombophilic defects together with other unprovoked risk factors could reduce the risk of recurrent VTE.
我们旨在研究急性肺栓塞中血栓形成倾向的患病率及预后情况。
进行了一项回顾性观察性研究，纳入2011年5月至2015年2月期间经放射学确诊为肺栓塞且接受血栓形成倾向筛查的患者。数据包括患者的人口统计学信息；对有或无血栓形成倾向的患者的临床表现、危险因素、实验室检查、治疗及预后进行分析和比较。
本研究共纳入227例肺栓塞患者，其中108例（47.6%）有血栓形成倾向。最常见的凝血异常包括蛋白S、蛋白C和抗凝血酶III缺乏以及高同型半胱氨酸血症。79例患者中只有7例被发现存在因子V莱顿突变。诊断为有血栓形成倾向的肺栓塞患者年龄小10岁，发病高峰年龄在30 - 39岁。深静脉血栓形成（=0.001）和肺栓塞（=0.001）的既往史是血栓形成倾向组的主要显著危险因素。有或无血栓形成倾向的患者中，不同风险类别的临床概率评分频率无显著差异。肺动脉高压是血栓形成倾向组的常见并发症（=0.009）。使用的药物包括华法林（74.7%）、依诺肝素（73.9%）和肝素（55.4%）。总体死亡率为8.4%，非血栓形成倾向组略高但无显著差异。
蛋白S、蛋白C和抗凝血酶III缺乏是血栓形成倾向缺陷的主要原因。遗传性血栓形成倾向患者发生急性肺栓塞的风险增加，尤其是在年轻人中。因此，早期检测血栓形成倾向缺陷以及其他不明原因的危险因素可降低复发性静脉血栓栓塞的风险。
