Venöz Tromborembolili Hastaların Etiyolojik açıdan Değerlendirilmesi

Amaç: Venöz tromborembolinin en önemli komponenti hayatı tehdit eden pulmoner embolidir. Bu çalışmanın amacı hastanemizde hematoloji bölümüne başvuran ve venöz tromboemboli tanısı konulan hastalarda etiyolojik açıdan değerlendirmedir. Gereç ve Yöntemler: Çalışmada hastanemizde 2009-2012 yılları arasında venöz tromboemboli tanısı almış ve tedavi uygulanmış hastalarda retrospektif olarak etiyolojik faktörleri değerlendirdik.Bulgular: Toplam 83 hasta değerlendirildi. Pulmoner embolinin istatistik olarak anlamlı olarak fazla görüldü (p=0,028) ve pulmoner embolinin >40 hastalar ≤30 hastalarla karşılaştırıldığında anlamlı olduğu görüldü (p=0,008).Sinüs Ven Trombozu yaş grupları arasında farklılık izlendi (p=0,005). SVT ≤30 ve >40 hastalarla karşılaştırıldığında (p=0,010 and p=0,017) anlamlı farklılık görüldü. FV Leiden normal/heterozigot+homozigot değerlendirildiğinde heterozigot+homozigot ≤30 ve >40 yaş üzerinde 31-40 yaş grubuyla karşılaştırıldığında daha düşük sıklıkta olduğu görülmüştür (p=0,013 and p=0,035) Sonuç: Kalıtsal ve edinilmiş risk faktörleri uygun bir şekilde sistematik olarak değerlendirilmelidir. Bu değerlendirmede, riskli vakalarda antikoagülan tedavi önerilmekte ve tedavinin süresini belirlemektedir.

Anahtar Kelimeler:

venöz tromboemboli, kalıtsal trombofili risk faktörleri, edinilmiş trombofili risk faktörleri, trombofili

Etiological Evaluation of Patients with Venous Thromboembolism

Objective: The most important component of VTE which poses threat to life is pulmonary embolism. The purpose of this study is to perform etiological examination of the patients who apply to department hematology of our hospital and diagnosed with VTE. Material and Method: In this study, we retrospectively evaluated the factors, which can play role for etiology, the patients with VTE who received treatment during 2009-2012 in our hospital.Results: The patients with VT is 83 in total. There was a statistically significant difference of PE (p=0,028), localization of pulmonary embolism was more frequent the age group of >40 compared to ≤30 (p=0,008). There was statistically significant difference among age groups for SVT (p=0,005), SVT was higher for age groups ≤30 and >40 compared to age group of 31-40 (p=0,010 and p=0,017). When the findings were evaluated as normal/heterozygote+homozygote for FV Leiden, the rates of heterozygote/homozygote was lower for the age groups of ≤30 and >40 compared to age group 31-40 (p=0,013 and p=0,035).Conclusion: Inherited and acquired risk factors must be systematically evaluated in an appropriate manner. This evaluation proposes anticoagulant therapy for risky cases, determines duration of the therapy.

Keywords:

Venous thromboembolism, inherited risk factors, acquired risk factors, thrombophilia,

PDF

___

1.Segal JB, Eng J, Janckes MW, Tamariz LJ, Bolger DT, Krishnan JA, et al. Diagnosis and treatment of deep venous thrombosis and pulmonary embolism. Agency for Healthcare Research and Quality Publication No. 03-E016,2003:1-169.
2. Devecioğlu Ö, Dündar S, Demir M, Karadoğan (Eds). Tromboz El Kitabı. Türk Hematoloji Derneği Yayınları 2004, Ankara.
3. Gerotziafas GT, Samama MM. Prophylaxis of venous thromboembolism in medical patients. Curr Opin Pulm Med. 2004;10:356-365.
4. Türk Toraks Derneği Pulmoner Tromboembolizm Tanı Ve Tedavi Uzlaşı Raporu.http://www.toraks.org.tr/news.php =1288, 2009.
5. de Visser MC, Rosendaal FR, Bertina RM. A reduced sensitivity for activated protein C in the absence of Faktör V Leiden increases the risk of venous thrombosis. Blood 1999; 93:1271.
6. Silverstein MD, Heit JA, Mohr DN, et al.Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.Arch Intern Med 1998;158:585Blood, 2007 110: 3097-3101
7. Roy L. Silverstein, Kenneth A. Bauer, Mary Cushman, Charles T. Esmon, William B. Ershler and Russell P. Tracy Venous thrombosis in the elderly: more questions than answers
8. de Bruijn SF, Stam J, Koopman MM, Vandenbroucke JP. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in (correction of who are) carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group. BMJ 1998; 316:589.
9 Castoldi E, Brugge JM, Nicolaes GA, et al. Impaired APC coFaktör activity of Faktör V plays a major role in the APC resistance associated with the Faktör V Leiden (R506Q) and R2 (H1299R) mutasyonus. Blood 2004; 103:4173.
10. Simioni P, Castoldi E, Lunghi B, et al. An underestimated combination of opposites resulting in enhanced thrombotic tendency. Blood 2005; 106:2363.
11. Ageno W, Becattini C, Brighton T, et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117:93.
12. Holst AG, Jensen G, Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation 2010; 121:1896.
13. Delluc A, Mottier D, Le Gal G, et al. Underweight is associated with a reduced risk of venous thromboembolism. Results from the EDITH case-control study. J Thromb Haemost
14. Eichinger S, Hron G, Bialonczyk C, et al. Overweight, obesity, and the risk of recurrent venous thromboembolism. Arch Intern Med 2008; 168:1678.
15. Severinsen MT, Overvad K, Johnsen SP, et al. Genetic susceptibility, smoking, obesity and risk of venous thromboembolism. Br J Haematol 2010; 149:273.
16. Pomp ER, le Cessie S, Rosendaal FR, Doggen CJ. Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations. Br J Haematol 2007; 139:289.
17. Helmerhorst FM, Bloemenkamp KW, Rosendaal FR, Vandenbroucke JP. Oral contraceptives and thrombotic disease: risk of venous thromboembolism. Thromb Haemost 1997; 78:327.
18. Nijziel MR, van Oerle R, Christella M, et al. Acquired resistance to activated protein C in breast cancer patients. Br J Haematol 2003; 120:117.
19. Tormene D, Simioni P, Prandoni P, et al. The risk of fetal loss in family members of probands with factor V Leiden mutation. Thromb Haemost 1999;82(4):1237–9. 20. Kierkegaard A, Norgren L, Olsson CG, et al. Incidence of deep vein thrombosis in bedridden non-surgical patients. Acta Med Scand 1987; 222:409
21. Türk Hematoloji Derneği.Edinsel Kanama Bozuklukları ve Kalıtsal Trombofili Tanı ve Tedavi Kılavuzu 2011;1:75-98
22. Lensen RP, Rosendaal FR, Koster T, et al. Apparent different thrombotic tendency in patients with factor V Leiden and protein C deficiency due to selection of patients. Blood 1996; 88:4205
23. de Bruijn SF, Stam J, Koopman MM, Vandenbroucke JP. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in (correction of who are) carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group. BMJ 1998; 316:589
24. Ganesan V, McShane MA, Liesner R, et al. Inherited prothrombotic states and ischaemic stroke in childhood. J Neurol Neurosurg Psychiatry 1998; 65:508.
25. G.Mommertz,F.Sıgala,T.R.Glowka et al. Differences of venous thromboembolic risks in vascular general and trauma surgery patients J Cardıovasc Surg 2007 ;48:727-733
26. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:381S.
27. McColl MD, Ramsay JE, Tait RC, et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78:1183.
28. Friederich PW, Sanson BJ, Simioni P, et al. Frequency of pregnancy-related venous thromboembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann Intern Med 1996; 125:955.
29. Grandone E, Margaglione M, Colaizzo D, et al. Genetic susceptibility to pregnancy-related venous thromboembolism: roles of factor V Leiden, prothrombin G20210A, and methylenetetrahydrofolate reductase C677T mutations. Am J Obstet Gynecol 1998; 179:1324.
30. Gerhardt A, Scharf RE, Zotz RB. Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium. Thromb Haemost 2003; 90:77.
31. Rey E, Kahn SR, David M, et al. Thrombophilic disorders and fetal loss: a metaanalysis. Lancet 2003;361(9361):901–8.