Prevalence and Outcomes of Thrombophilia in Patients with Acute Pulmonary Embolism
Authors Obaid M, El-Menyar A, Asim M, Al-Thani H
Received 9 December 2019
Accepted for publication 21 February 2020
Published 9 March 2020 Volume 2020:16 Pages 75—85
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Pietro Scicchitano
Munzir Obaid,1 Ayman El-Menyar,2,3 Mohammad Asim,2 Hassan Al-Thani1
1Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar; 2Department of Surgery, Clinical Research, Trauma and Vascular Surgery Section, HGH, Doha, Qatar; 3Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
Correspondence: Ayman El-Menyar
Weill Cornell Medical College, Consultant Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
Tel +974 44394029
Fax +974 44394031
Background: We aimed to study the prevalence and outcomes of thrombophilia in acute pulmonary embolism.
Methods: A retrospective observational study was conducted to include patients with a radiologically confirmed diagnosis of PE screened for thrombophilia from May 2011 to February 2015. Data included patients’ demographics; clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed and compared in patients with and without thrombophilia.
Results: A total of 227 cases of PE were included in the study, of which 108 (47.6%) had thrombophilia. The most frequent coagulopathic abnormality included deficiency of protein S, protein C, and antithrombin III and hyperhomocysteinemia. Only seven out of 79 patients were found to have factor V Leiden. PE patients diagnosed with thrombophilia were 10 years younger in age and peaked in the age range 30– 39 years. Prior history of DVT (p=0.001) and PE (p=0.001) were the main significant risk factors in the thrombophilia group. The frequency of different risk categories of clinical probability scores did not differ significantly among those with and without thrombophilia. Pulmonary hypertension was a common complication in the thrombophilia group (P=0.009). Medications used included warfarin (74.7%), enoxaparin (73.9%), and heparin (55.4%). The overall mortality rate was 8.4%, and was non-significantly higher in the non-thrombophilia group.
Conclusion: Deficiencies of protein S, protein C, and antithrombin III are the leading causes of thrombophilic defects. Patients with hereditary thrombophilia are at increased risk of acute PE, particularly among young individuals. Therefore, early detection of thrombophilic defects together with other unprovoked risk factors could reduce the risk of recurrent VTE.
Keywords: pulmonary embolism, thrombophilia, risk factors, thromboembolism, outcome
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