Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden Thrombophilia Study

Autor:	H de Ronde, Ernest Briët, Frits R. Rosendaal, Rogier M. Bertina, Jan P. Vandenbroucke, Ted Koster
Rok vydání:	1993
Předmět:	Adult Male Heterozygote medicine.medical_specialty Adolescent medicine.drug_class Population Thrombophilia Gastroenterology Risk Factors Internal medicine Odds Ratio medicine Factor V Leiden Humans education Blood Coagulation Aged education.field_of_study biology business.industry Homozygote Anticoagulant Factor V General Medicine Middle Aged Thrombophlebitis medicine.disease Thrombosis Surgery Venous thrombosis Case-Control Studies biology.protein Female Blood Coagulation Tests Activated protein C resistance business Protein C
Zdroj:	The Lancet. 342:1503-1506
ISSN:	0140-6736
DOI:	10.1016/s0140-6736(05)80081-9
Popis:	Summary We undertook a population-based case-control study to test the clinical importance of a hereditary abnormality in the coagulation system, characterised by poor anticoagulant response to activated protein C (APC), which is associated with familial thrombophilia. The abnormality was detected in 64 (21%) of 301 unselected consecutive patients younger than 70 years, with a first, objectively confirmed episode of deep-vein thrombosis and without underlying malignant disease. Among 301 healthy control subjects matched for age and sex, the frequency was 5% (14 subjects). Thus, there is a seven-fold increase in risk of deep-vein thrombosis in subjects with a poor response to APC (matched odds ratio 6·6 [95% Cl 3·6–12·0]). In addition, there was a clear inverse relation between the degree of response to APC and thrombosis risk. In the families of the patients an autosomal dominant mode of transmission of the abnormality was confirmed. 9 of 10 thrombosis patients with a poor response to APC had 1 parent with a similar poor response, whereas 9 of 10 patients with normal tests had parents with equally normal tests. The abnormality was found in both parents of 1 patient with an extremely poor response to APC; this patient is probably homozygous for the abnormality. We conclude that the poor response to APC is the most important hereditary cause of venous thrombosis. Its high prevalence in a series of unselected patients will make testing of all thrombosis patients for this abnormality worth while.
Databáze:	OpenAIRE
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