Prevalence and Risk of Thrombophilia Defects in Vascular Patients

Abstract

This paper reviews the available data on the prevalence of thrombophilia defects in patients with peripheral vascular disease (PVD) and attempts to delineate the risk of failure of vascular intervention in these patients. The prevalence of thrombophilia in stable claudicants is 25% and increases to 40% in those requiring revascularisation, compared to only 11% in the control group. The overall prevalence of thrombophilia defects in patients with premature atherosclerosis appears to be between 15 and 30%. The prevalence in the typical cohort of patients with PVD appears to be similar. All these studies have recruited patients with symptoms significant enough to warrant intervention. The overall prevalence of thrombophilia calculated from these trials, therefore, may not be truly indicative of the general vascular population who may not even present primary or secondary healthcare. The risk of thrombotic occlusion following arterial revascularisation in patients with an identified thrombophilia defect appears to be almost three times that of patients with no evidence of a thrombophilia defect. The best management of these patients has not been determined and needs to be evaluated by prospective randomized trials.

The prevalence of thrombophilia in patients with symptomatic peripheral vascular disease

“…The overall prevalence of thrombophilia in this study was 27·3 per cent, almost four times that found in the control group. This supports the reported literature suggesting that the prevalence of thrombophilia defects in patients with symptomatic peripheral vascular disease is higher than in the general population34. The prevalence of protein S deficiency in this study was 11·3 per cent, higher than other reported series, and possibly caused by an acquired protein S deficiency (influenced by age, sex and smoking).…”

“…The commonest thrombophilia abnormality detected in the general population is activated protein C resistance due to factor V Leiden (7 per cent1), equivalent to that found in the control group in the present study. The prevalence of factor VIII is 4 per cent, the prevalence of prothrombin mutation and lupus anticoagulant is 2–3 per cent each, and other thrombophilia defects occur in less than 1 per cent of the population14–16, 33, 34.…”

Role of Thrombophilia in Premature Peripheral Arterial Obstructive Disease – Experience of a Vascular Centre in China

“…4 Thrombophilic abnormalities may arise in the context of a variety of inherited or acquired immunological, myeloproliferative, inflammatory or coagulation cascade disorders, 5e10 all of which need to be looked for since these patients with thrombophilia are at increased risk for early bypass failure, frequently require multiple vascular interventions and have relatively low limb salvage rates compared to patients with peripheral vascular disease but without thrombophilia. 10,11 This retrospective analysis was undertaken to better understand aetiology profile of thrombophilia involved in premature PAOD in China, and to evaluate the influence of thrombophilia on the patency of the revascularisations done in these young patients.…”