Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

Weingarz, Lea; Schindewolf, Marc; Schwonberg, Jan; Hecking, Carola; Wolf, Zsuzsanna; Erbe, Matthias; Lindhoff-Last, Edelgard; Linnemann, Birgit (2015). Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation. Vasa - European journal of vascular medicine, 44(4), pp. 313-323. Huber 10.1024/0301-1526/a000447

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BACKGROUND

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Schindewolf, Marc

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0301-1526

Publisher:

Huber

Language:

English

Submitter:

Heidi Lobsiger

Date Deposited:

14 Dec 2015 10:46

Last Modified:

14 Dec 2015 10:46

Publisher DOI:

10.1024/0301-1526/a000447

PubMed ID:

26314364

Uncontrolled Keywords:

Age antiphospholipid antibodies factor VIII hereditary thrombophilia recurrent venous thromboembolism

URI:

https://boris.unibe.ch/id/eprint/74045

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