Thrombophilia and outcomes of venous thromboembolism in older patients.

Autor: Méan M; Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland., Breakey N; Department of Internal Medicine, Spital Emmental, Burgdorf, Switzerland., Stalder O; CTU Bern, University of Bern, Bern, Switzerland., Alberio L; Service and Central Laboratory of Hematology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland., Limacher A; CTU Bern, University of Bern, Bern, Switzerland., Angelillo-Scherrer A; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Departement of BioMedical Research, University of Bern, Bern, Switzerland., Fontana P; Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland., Beer HJ; Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland., Rodondi N; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Institute of Primary Health Care, University of Bern, Bern, Switzerland., Aujesky D; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland., Lämmle B; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.; Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.; Haemostasis Research Unit, University College London, UK., Escher R; Department of Internal Medicine, Spital Emmental, Burgdorf, Switzerland.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2022 Dec 16; Vol. 7 (1), pp. 100015. Date of Electronic Publication: 2022 Dec 16 (Print Publication: 2023).
DOI: 10.1016/j.rpth.2022.100015
Abstrakt: Background: Limited data exist on thrombophilic risk factors and clinical outcomes in the elderly with venous thromboembolism (VTE).
Objectives: To describe the prevalence of laboratory thrombophilic risk factors and their association with VTE recurrence or death in a cohort of elderly people with VTE.
Methods: In 240 patients aged ≥65 years with acute VTE without active cancer or an indication for extended anticoagulation, we performed laboratory thrombophilia testing 1 year after the index VTE. Recurrence or death was assessed during the 2-year follow-up.
Results: A total of 78% of patients had ≥1 laboratory thrombophilic risk factor(s). Elevated levels of von Willebrand factor, homocysteine, coagulant activity of factor VIII (FVIII:C), fibrinogen, FIX:C, and low antithrombin activity were the most prevalent risk factors (43%, 30%, 15%, 14%, 13%, and 11%, respectively). Additionally, 16.2% of patients experienced VTE recurrence and 5.8% of patients died. Patients with a von Willebrand factor of >182%, FVIII:C level >200%, homocysteine level >15μmol/L, or lupus anticoagulant had a significantly higher rate of recurrence than those without these risk factors (15.0 vs. 6.1 [ P  = .006], 23.5 vs. 8.2 [ P  = .01], 17.0 vs. 6.8 [ P  = .006], and 89.5 vs. 9.2 [ P  = .02] events per 100 patient-years, respectively). Furthermore, patients with a high fibrinogen level or hyperhomocysteinemia with a homocysteine level ≥30 μmol/L had significantly higher mortality than patients with normal levels (18.5 vs. 2.8 [ P  = .049] and 13.6 vs. 2 [ P  = .002] deaths per 100 patient-years, respectively). After adjustments for relevant confounders, these associations remained unchanged.
Conclusion: Laboratory thrombophilic risk factors are common in elderly people with VTE and allow for the identification of a population at the risk of worse clinical outcomes.
(© 2022 The Author(s).)
Databáze: MEDLINE
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