The Risk of Recurrent Venous Thromboembolism in Patients with an Arg<sup>506</sup>→Gln Mutation in the Gene for Factor V (Factor V Leiden)

Simioni, Paolo; Prandoni, Paolo; Lensing, Anthonie W. A.; Scudeller, Alberta; Sardella, Corrado; Prins, Martin H.; Villalta, Sabina; Dazzi, Francesco; Girolami, Antonio

doi:10.1056/nejm199702063360602

Cited by 368 publications

(216 citation statements)

References 22 publications

(29 reference statements)

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“…[13][14][15] It is still debated whether carriers of heterozygous factor V Leiden or the G20210A prothrombin mutation, the two most common thrombophilic alterations, are at higher risk of recurrence. Such a conclusion has been drawn in some studies 16,17 but was not confirmed by other authors. 18,19 In a recent prospective study 20 in subjects with a previous first VTE event, we showed that normal D-dimer levels obtained after OAT withdrawal had a very high negative predictive value for VTE recurrence.…”

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confidence: 63%

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

et al. 2003

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Background-We have shown that normal D-dimer levels obtained after the discontinuation of oral anticoagulant treatment (OAT) has a high negative predictive value for recurrent venous thromboembolism (VTE). The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE in subjects with a previous unprovoked event who are either carriers of inherited thrombophilia or not. Methods and Results-We prospectively evaluated 599 patients (301 males) with a previous VTE episode. They were repeatedly examined for D-dimer levels after OAT withdrawal and were screened for inherited thrombophilic alterations. Alterations were detected in 130 patients (21.7%), factor V Leiden (70 patients; 2 of whom were homozygotes) and prothrombin mutation (38 patients) were the most prevalent ones. Recurrent events were recorded in 58 subjects (9.7%) during a follow-up of 870.7 patient-years. Altered D-dimer levels at 1 month after OAT withdrawal were associated with a higher rate of subsequent recurrence in all subjects investigated, especially in those with an unprovoked qualifying VTE event (hazard ratio, 2.43; 95% confidence interval, 1.18 to 4.61) and in those with thrombophilia (hazard ratio, 8.34; 95% confidence interval, 2.72 to 17.43). The higher relative risk for recurrence of altered D-dimer was confirmed by multivariate analysis after adjustment for other risk factors. The negative predictive value of D-dimer was 92.9% and 95.8% in subjects with an unprovoked qualifying event or with thrombophilia, respectively. Conclusions-D-dimer levels measured 1 month after OAT withdrawal have a high negative predictive value for recurrence in subjects with unprovoked VTE who are either carriers or not carriers of congenital thrombophilia.

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confidence: 63%

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

et al. 2003

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“…28 Thus, the prevalences of the FVL mutation in venous thrombosis at either a cerebral or a peripheral location are almost identical. Recurrent peripheral venous thromboembolism was found in 39.7% of patients having the FVL mutation.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with FVL-negative patients, the hazard ratio was 2.4. 28 In only 3 of the previously discussed patients with CVT and FVL, a history of previous venous thrombosis had been reported. 12,21 Quite contrary, in our cohort, patients with the FVL mutation had antecedent DVT significantly more frequently (62.5%) than FVL-negative patients (PϽ0.005).…”

Section: Discussionmentioning

confidence: 99%

Factor V Leiden Mutation Is a Risk Factor for Cerebral Venous Thrombosis

Lüdemann

Nabavi

Junker

et al. 1998

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Background and Purpose-Different coagulation disorders have been associated with cerebral venous thrombosis (CVT).Until now, fewer than 50 patients have been reported with CVT and the factor V Leiden (FVL) mutation. Although the prevalence of FVL-positive patients with CVT ranged from 10% to 25%, it was as low as 0.5% to 3% in the control groups. Most other studies had not systematically searched for concomitant risk factors or previous thromboembolic events. To better define the relevance of the FVL mutation in conjunction with additional risk factors in CVT, we conducted the present case-control study. Methods-Fifty-five patients with CVT were compared with 272 healthy controls. A standardized interview regarding established risk factors for venous thrombosis and the patients' and their families' histories for thromboembolic events was performed. The presence of the FVL mutation was determined by polymerase chain reaction on DNA obtained from peripheral blood leukocytes. Results-Of 55 patients, 8 (14.5%) were heterozygous for the FVL mutation compared with 17 of 272 controls (6.25%).The relative risk for the presence of FVL was 2.55 (95% confidence interval, 1.04 to 6.26; Pϭ0.04). Additional risk factors for CVT were frequently found in both the presence and absence of FVL. Recurrence of venous thromboembolic events was more frequent in patients with the FVL mutation (5 of 8 patients, 62.5%) than in those without this anomaly (8 of 47 patients, 17%; PϽ0.005). Conclusions-Our

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“…Screening for mutations and conditions associated with thrombophilia (antithrombin, protein C, or protein S deficiency; factor V Leiden; prothrombin G20210A mutation; hyperhomocysteinemia; and lupus-like anticoagulants) was left to the discretion of treating physicians and was performed according to previously described methods. [29][30][31][32][33] Carriers of thrombophilia were classified as having spontaneous or secondary thrombosis according to their clinical presentation.…”

Section: Patientsmentioning

confidence: 99%

An Association between Atherosclerosis and Venous Thrombosis

et al. 2003

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The Risk of Recurrent Venous Thromboembolism in Patients with an Arg⁵⁰⁶→Gln Mutation in the Gene for Factor V (Factor V Leiden)

Abstract: The risk of recurrent venous thromboembolism in patients with Arg506->G1n mutation in the gene for factor V (factor V Leiden) Simioni, P.; Prandoni, P.; Lensing, A.W.A.; Scudeller, A.; Sardella, C.; Prins, M.H.; Villalta, S.; Dazzi, F.; Girolami, A.

Cited by 368 publications

References 22 publications

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Factor V Leiden Mutation Is a Risk Factor for Cerebral Venous Thrombosis

An Association between Atherosclerosis and Venous Thrombosis

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The Risk of Recurrent Venous Thromboembolism in Patients with an Arg506→Gln Mutation in the Gene for Factor V (Factor V Leiden)

Abstract: The risk of recurrent venous thromboembolism in patients with Arg506->G1n mutation in the gene for factor V (factor V Leiden) Simioni, P.; Prandoni, P.; Lensing, A.W.A.; Scudeller, A.; Sardella, C.; Prins, M.H.; Villalta, S.; Dazzi, F.; Girolami, A.

Cited by 368 publications

References 22 publications

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Factor V Leiden Mutation Is a Risk Factor for Cerebral Venous Thrombosis

An Association between Atherosclerosis and Venous Thrombosis

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The Risk of Recurrent Venous Thromboembolism in Patients with an Arg⁵⁰⁶→Gln Mutation in the Gene for Factor V (Factor V Leiden)