Effect of hemostatic risk factors on the individual probability of thrombosis during pregnancy and the puerperium.
In a retrospective study of 190 women with a first history of venous thromboembolism during pregnancy and the puerperium and 190 age-matched women with at least one prior pregnancy and no history of venous thromboembolism, the individual probability of thrombosis was determined. Assuming an overall risk of 1 in 1500 pregnancies, the probability of pregnancy-related thrombosis in carriers of homozygous factor V Leiden was 1 in 80 (odds ratio 20.6, p=0.005) and among carriers of combined heterozygous factor V Leiden and heterozygous G20210A mutation in the prothrombin gene 1 in 20 (odds ratio 88, p<0.001). The probability of thrombosis per pregnancy among women with elevated levels of factor VIII:C (>172 % activity) was 1 in 385 (odds ratio 4.5, p<0.001) and among those with increased levels of von Willebrand factor antigen (>190 %) 1 in 435 (odds ratio 4.0, p=0.002), independent of elevated factor VIII:C levels. The high prevalence of combined and homozygous defects of hemostatic components (21.6%) in patients as compared with normal women (0.86%) supports the concept that venous thromboembolism is a multicausal disorder.
Gerhardt
Andrea
A
Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center, Dusseldorf, Germany.
Scharf
Rüdiger E
RE
Zotz
Rainer B
RB
D020413:3' Untranslated Regions / Q000235:genetics; D020016:Activated Protein C Resistance / Q000150:complications / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D005165:Factor V / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D020151:Protein C Deficiency / Q000150:complications / Q000453:epidemiology; D018455:Protein S Deficiency / Q000150:complications / Q000453:epidemiology; D011516:Prothrombin / Q000235:genetics; D011644:Puerperal Disorders / Q000097:blood / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology; D014841:von Willebrand Factor / Q000032:analysis
D020413:3' Untranslated Regions; C095381:factor V Leiden; D014841:von Willebrand Factor; D005165:Factor V; D011516:Prothrombin