Venous thromboembolism and women's health

Speed, Victoria; Roberts, Lara N.; Patel, Jignesh P.; Arya, Roopen

doi:10.1111/bjh.15608

Cited by 30 publications

(23 citation statements)

References 108 publications

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“…The authors report more bleeding in women compared to men, reflective of a higher mg/kg dose of rivaroxaban in women (0·25 mg/kg) relative to men (0·21 mg/kg), P < 0·05, with the dose correlating with rivaroxaban concentrations: median rivaroxaban trough concentration was 12 ng/ml vs. 18 ng/ml in men and women, respectively. The bleeding observed in women was also driven by abnormal uterine bleeding (AUB), which appears to be more common, or more commonly reported, with DOACs compared to traditional anticoagulants (Speed et al , ).…”

Section: What Evidence Has Been Reported From the Real‐world?mentioning

confidence: 99%

“…The authors report more bleeding in women compared to men, reflective of a higher mg/kg dose of rivaroxaban in women (0Á25 mg/kg) relative to men (0Á21 mg/kg), P < 0Á05, with the dose correlating with rivaroxaban concentrations: median rivaroxaban trough concentration was 12 ng/ml vs. 18 ng/ml in men and women, respectively. The bleeding observed in women was also driven by abnormal uterine bleeding (AUB), which appears to be more common, or more commonly reported, with DOACs compared to traditional anticoagulants (Speed et al, 2018). Testa et al (2018) have reported analysis from the START laboratory registry, where 565 consecutive anticoagulation-na€ ıve patients with AF had trough DOAC concentrations measured to evaluate the relationship between concentration and thromboembolic events.…”

Section: What Can Be Learnt From the Clinical Trials Regarding Doac Cmentioning

confidence: 99%

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Progress in the monitoring of direct oral anticoagulant therapy

et al. 2019

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Summary The availability of direct oral anticoagulants (DOACs) has led to a paradigm shift in the field of anticoagulation, with DOACs increasingly being prescribed for patients in preference to vitamin K antagonists and low molecular weight heparin. Despite good experience with the use of these agents at fixed doses, there are clinical scenarios where monitoring is recommended. Data from phase III studies of the DOACs and small real‐world studies suggest a relationship between DOAC concentration and clinical events. The DOACs have differing impacts on the common tests of haemostasis and it is important that clinicians are familiar with the sensitivity of the reagents used in their laboratory to individual DOACs. The specific DOAC drug concentrations can be assayed in the laboratory, when required, to guide appropriate clinical decision‐making. Studies from the real world with sufficient numbers evaluating the association of DOAC concentrations with outcomes should be a research priority in order to understand if we could do better through dose individualisation.

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Section: What Evidence Has Been Reported From the Real‐world?mentioning

confidence: 99%

Section: What Can Be Learnt From the Clinical Trials Regarding Doac Cmentioning

confidence: 99%

Progress in the monitoring of direct oral anticoagulant therapy

et al. 2019

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“…Among these, Factor V Leiden (FVL, R506Q variant) causes resistance of FV to protein C inhibition; the G20210A variant of prothrombin enhances the synthesis and the activity of Factor II (FII), and the C677T variant of methylene-tetrahydrofolate reductase (MTHFR) impairs the activity of the enzyme, causing an increase in serum homocysteine. In addition to these well-known prothrombotic gene variants, other variants that are thought to play a role in some forms of venous thrombosis include FV H1299R (FVR2), MTHFR A1298C, factor XIII (FXIII) V34L, human platelet antigen (HPA)-1 L33P, beta-fibrinogen -455G>A and plasminogen activator inhibitor (PAI)-1 4G/5G variants [5,10].…”

Section: Introductionmentioning

confidence: 99%

Molecular Analysis of Prothrombotic Gene Variants in Venous Thrombosis: A Potential Role for Sex and Thrombotic Localization

Cernera

Minno

Amato

et al. 2020

JCM

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Background: Requests to test for thrombophilia in the clinical context are often not evidence-based. Aim: To define the role of a series of prothrombotic gene variants in a large population of patients with different venous thromboembolic diseases. Methods: We studied Factor V Leiden (FVL), FVR2, FII G20210A, Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, beta-fibrinogen -455 G>A, FXIII V34L, and HPA-1 L33P variants and PAI-1 4G/5G alleles in 343 male and female patients with deep vein thrombosis (DVT), 164 with pulmonary embolism (PE), 126 with superficial vein thrombosis (SVT), 118 with portal vein thrombosis (PVT), 75 with cerebral vein thrombosis (CVT) and 119 with retinal vein thrombosis (RVT), and compared them with the corresponding variants and alleles in 430 subjects from the general population. Results: About 40% of patients with DVT, PE and SVT had at least one prothrombotic gene variant, such as FVL, FVR2 and FII G20210A, and a statistically significant association with the event was found in males with a history of PE. In patients with a history of PVT or CVT, the FII G20210A variant was more frequent, particularly in females. In contrast, a poor association was found between RVT and prothrombotic risk factors, confirming that local vascular factors have a key role in this thrombotic event. Conclusions: Only FVL, FVR2 and FII G20210A are related to vein thrombotic disease. Other gene variants, often requested for testing in the clinical context, do not differ significantly between cases and controls. Evidence of a sex difference for some variants, once confirmed in larger populations, may help to promote sex-specific prevention of such diseases.

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“…[5] In the UK, VTE is the leading direct cause of maternal death (12.9% of patients between 2013 and 2015) and the fifth most common cause of death overall in pregnancy. [6] Approximately 80% of venous thrombotic events are deep-vein thrombosis (DVT) and 20% pulmonary embolism. [7] The risk of VTE increases from the time of conception, with the highest risk at the time of delivery and immediately thereafter, especially in the first 3 -6 postpartum weeks, with approximately half of VTE events occurring during that period.…”

Section: How Many Patients Develop Vte In Pregnancy?mentioning

confidence: 99%

Venous thromboembolism in pregnancy

Wessels

2019

S Afr Med J

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Venous thromboembolism and women's health

Cited by 30 publications

References 108 publications

Progress in the monitoring of direct oral anticoagulant therapy

Progress in the monitoring of direct oral anticoagulant therapy

Molecular Analysis of Prothrombotic Gene Variants in Venous Thrombosis: A Potential Role for Sex and Thrombotic Localization

Venous thromboembolism in pregnancy

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