Do factor V Leiden and prothrombin G20210A mutations predict recurrent venous thromboembolism in older patients?

Méan, Marie; Limacher, Andreas; Stalder, Odile; Angelillo, Anne; Alberio, Lorenzo; Fontana, Pierre; Beer, Hans-Jürg; Rodondi, Nicolas; Laemmle, Bernhard; Aujesky, Drahomir (2017). Do factor V Leiden and prothrombin G20210A mutations predict recurrent venous thromboembolism in older patients? American journal of medicine, 130(10), 1220.e17-1220.e22. Elsevier 10.1016/j.amjmed.2017.05.026

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BACKGROUND

The value of genetic thrombophilia testing in elderly patients with an unprovoked venous thromboembolism is unclear. We assessed whether the factor V Leiden and the prothrombin G20210A mutation are associated with recurrent venous thromboembolism in elderly patients in a prospective multicenter cohort study.

METHODS

We genotyped the factor V Leiden and the prothrombin G20210A mutation in 354 consecutive in- and outpatients aged ≥65 years with a first unprovoked venous thromboembolism from nine Swiss hospitals. Patients and managing physicians were blinded to testing results. The outcome was recurrent symptomatic venous thromboembolism during follow-up. We examined the association between the factor V Leiden and the prothrombin G20210A mutation and venous thromboembolism recurrence using competing risk regression, adjusting for age, sex, and periods of anticoagulation as a time-varying covariate.

RESULTS

Overall, 9.0% of patients had a factor V Leiden and 3.7% a prothrombin G20210A mutation. The At 36 months of follow-up, patients with a factor V Leiden and a prothrombin G20210A mutation had a cumulative incidence of recurrent venous thromboembolism of 12.9% (95% confidence interval [CI] 5.1-30.8%) and 18.5% (95% CI 4.9-56.5%), respectively, compared to 16.7% (95% CI 12.5-22.1%) of patients without mutation (P=0.91 by the log-rank test). After adjustment, neither the FV Leiden (sub-hazard ratio [SHR] 0.98; 95% CI 0.35-2.77) nor the prothrombin G20210A mutation (SRH 1.15; 95% CI 0.25-5.19) was associated with recurrent venous thromboembolism.

CONCLUSION

Our results suggest that testing for genetic thrombophilia may not be beneficial in elderly patients with a first unprovoked venous thromboembolism.

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