ABSTRACT
Venous thromboembolism (VTE) is a common source of morbidity and mortality in developed countries. Heritable risk factors for VTE (thrombophilias) can be identified in 30-50% of affected patients. Factor V Leiden, prothrombin 20210G>A, and deficiencies of antithrombin, protein C and protein S increase the risk of a first VTE. However, an individual's thrombotic risk is determined by a complex interplay of genetic, acquired and circumstantial risk factors. At least 50% of VTE events in thrombophilic individuals are provoked by predisposing factors such as immobility, surgery, trauma, cancer, hormonal therapy and pregnancy. Non-modifiable risk factors such as advancing age and family history also increase thrombotic risk. An evidence-based risk factor evaluation is an essential step in VTE prevention. This review will educate genetics professionals about inherited and acquired risk factors for VTE and discuss recommendations for management of asymptomatic individuals with thrombophilia.
Subject(s)
Disease Management , Thrombophilia/genetics , Venous Thromboembolism/prevention & control , Antithrombin III/genetics , Antithrombin III/metabolism , Epistasis, Genetic , Evidence-Based Practice/methods , Factor V/genetics , Genetic Counseling , Genetic Diseases, Inborn/genetics , Genetic Diseases, Inborn/metabolism , Genetic Testing , Genotype , Health Personnel , Humans , Mutation , Protein S/genetics , Protein S/metabolism , Risk Factors , Thrombophilia/metabolism , Venous Thromboembolism/genetics , Venous Thromboembolism/metabolismSubject(s)
Heparin, Low-Molecular-Weight/therapeutic use , Abortion, Habitual/drug therapy , Abortion, Habitual/prevention & control , Abortion, Spontaneous/prevention & control , Anticoagulants/therapeutic use , Clinical Protocols/standards , Female , Humans , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Pregnancy Complications, Hematologic/prevention & control , Pregnancy Outcome , Pregnancy, High-Risk , Risk Factors , Thrombophilia/complicationsSubject(s)
Pregnancy Complications, Hematologic/etiology , von Willebrand Diseases/complications , Deamino Arginine Vasopressin/therapeutic use , Female , Hemorrhage/etiology , Humans , Infant, Newborn , Infant, Newborn, Diseases/etiology , Pregnancy , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Hematologic/drug therapy , von Willebrand Diseases/diagnosis , von Willebrand Diseases/drug therapyABSTRACT
The initial studies of low-molecular-weight heparin in the treatment of deep-vein thrombosis excluded pregnant women and patients with acute pulmonary embolism or a known hypercoagulable disorder. However, none of these needs to be a contraindication, and outpatient treatment is possible, provided that proper patient selection and follow-up are implemented.
Subject(s)
Anticoagulants/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Pregnancy Complications, Hematologic/drug therapy , Pulmonary Embolism/drug therapy , Thrombophlebitis/drug therapy , Adult , Anticoagulants/blood , Female , Heparin, Low-Molecular-Weight/blood , Humans , Pregnancy , Randomized Controlled Trials as TopicABSTRACT
Bioprosthetic valve calcification is usually assessed pathologically by gross inspection, radiographic studies, and histologic examination. Quantitation of mineral content by chemical assay has not been reported for failed clinical valves removed from adults. In this study, calcium determination by atomic absorption spectroscopy was done on 52 removed porcine valves after routine pathologic examination, including specimen radiography done by a standard technique. Specimens included 31 valves with calcific primary tissue failure, two calcified (but not overtly dysfunctional) valves removed simultaneously with failed valves, 14 nondeteriorated valves obtained at reoperation or autopsy after long-term implantation, and five valves removed within 1 month after insertion. Chemically determined mineral content varied widely among patients and duration of function. Valves with calcific failure had 113 +/- 68 micrograms/mg calcium overall (mean +/- SD) after 36 to 156 months (mean 87) of function. Almost all dysfunctional porcine valves with radiographically demonstrated calcific deposits had greater than 34 and 67 micrograms/mg calcium for mitral and aortic valves, respectively. Nondeteriorated valves (implanted 8 to 145 months, mean 57) had 5 +/- 6 micrograms/mg calcium. Failed aortic valves had more calcium than failed mitral valves and valves with calcific stenosis more than valves with regurgitation caused by calcification with tearing. Correlation of semiquantitative radiographic grading with chemically determined valve mineral was good, indicating that radiographic assessment of calcification may be used reliably for clinical comparisons between valves.
