The risk of periodical venous thro...

The risk of periodical venous thromboembolism (VTE) after cessation of anticoagulant therapy is estimated to be around 12 to 18 percent after brace years. Although the risk can be reduc with anticoagulant therapy, the risks of the latter therapy and the likelihood of returning thrombosis cannot easily be predicted for individual patients. Heritable thrombophilic factors are believed to be important in renewed thromboembolism in at least single third of patients, but the character of testing remains unclear. Baglin and colleagues studied the risk of resort in 570 patients with VTE paying special attention to the character of testing for heritable thrombophilic conditions.

The authors studied all patients receiving anticoagulant therapy at an English regional center following a first episode of VTE Patients with malignant disease or antiphospholipid activity were exclud from the studious mood as were patients with thrombose of the mesenteric or cerebral veins, because these could indicate a different proces than VTE Patients were categorized into four clumps based on clinical risk factors. Patients with modern surgery were classified as collection A, pregnancy-associated cases constituted arrange B, patients with no risk factors were classified as assemblage C, and those with nonsurgical risk factors (such as immobilization, modern travel, estrogen therapy) were placed in assign places to D. All patients were giveed thrombophilia testing (including antithrombin, protein C or s factor V Leiden, lupus anticoagulant, and cardiolipin), and 85 percent agreed to be exhibitioned Patients were monitored for episodes of periodical VTE and followed-up at six month and at the same and two years after discontinuing anticoagulation.

Of the 570 patients monitored, 86 were in collection A, 12 in group B 193 in form into groups C, and 279 in clump D. The median age was 67 (range, 19 to 100 years), and 44 percent were men Pulmonary embolism was the initial adventure in 165 study participants (29 percent) Patients were treated with anticoagulation for a mean duration of 24 to 28 weeks. During follow-up 26 patients died of non-VTE related causes. The cumulative resort rate of VTE at brace years was 11 percent. No periodical cases occurred in groups A or B however the cumulative recurrence rate was 194 percent in collection C (no risk factors) and 88 percent in assemblage D. The recurrence rate of VTE was no higher in the 130 patients with evidence of a heritable thrombophilic lack than in the 359 patients without thrombophilia. This consequence was not altered by excluding the patients from assemblages A and B or when analyzed independently for the most numerous common defects, such as factor V Leiden.

The authors describe three important conclusions based in succession this study. First, the risk of the having recourse of postoperative VTE is surpassingly low. Second, the two-year cumulative resort rate after an unprecipitated VTE is approximately 20 percent Third, testing for heritable thrombophilic destitutions in patients with VTE does not assist in predicting resort Their findings correlate with those of other late studies questioning the value of testing for thrombophilia. so testing is not useful in chiefly patients with VTE but may test useful in those with a stout family history of thrombosis.

Baglin T et al. Incidence of periodical venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort thought Lancet August 16, 2003; 362:523-6

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