Clinical manifestations and management of inherited thrombophilia: retrospective analysis and follow-up after diagnosis of 238 patients with congenital deficiency of antithrombin III, protein C, protein S.
The clinical history of 238 patients with inherited thrombophilia (AT III = 94, PC = 103, PS = 41) was analyzed retrospectively at diagnosis and in the follow-up period after diagnosis. At diagnosis 129 patients (54%) had suffered from thrombosis, with a recurrence rate of 48%. The most frequent onset manifestation was deep vein thrombosis of lower limbs (58%). Thrombotic history started before 40 in 80% of the cases. Forty-nine percent of the venous thromboses were preceded by a triggering event, in most cases pregnancy (17%) and surgery (12%). After diagnosis, follow-up lasted a total of 1,113 pt-years. A policy of short-term prophylaxis during risk situations for all patients and long-term prophylaxis in symptomatic patients failed to prevent venous thrombotic episodes (diagnosed by objective methods) in 4 previously asymptomatic subjects and recurrence in 7 previously symptomatic subjects. After knowledge of the patients' diagnosis the incidence of venous thrombosis/100 pt-years was reduced as compared before diagnosis as total episodes (onset+recurrencies) (1.0 vs 1.9), onset episodes (0.7 vs 1.3) and recurrent episodes (1.3 vs 4.8), even though the differences were not statistically significant. However most of the venous thromboses occurred at a more advanced age (67% after 40 years) and without any apparent cause (83%), at significant variance with the period preceding the diagnosis; in particular the incidence of venous thrombotic onset in patients younger than 40 passed from 1.3/100 pt-years to 0.2/100 pt-years. In 6 recurrences after diagnosis a poor compliance for antithrombotic treatment was recognized.(ABSTRACT TRUNCATED AT 250 WORDS)
De Stefano
V
V
Divisione di Ematologia, Università Cattolica, Roma, Italy.
Leone
G
G
Mastrangelo
S
S
Tripodi
A
A
Rodeghiero
F
F
Castaman
G
G
Barbui
T
T
Finazzi
G
G
Bizzi
B
B
Mannucci
P M
PM
D000328:Adult; D017668:Age of Onset; D020152:Antithrombin III Deficiency; D004198:Disease Susceptibility / Q000175:diagnosis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000517:prevention & control; D020151:Protein C Deficiency; D018455:Protein S Deficiency / Q000175:diagnosis / Q000235:genetics*; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013927:Thrombosis / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control / Q000628:therapy
D005343:Fibrinolytic Agents