title: Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation.
abstract: BACKGROUND
  Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient's age at the time of the first VTE.
  
  
  METHODS
  Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy.
  
  
  RESULTS
  Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years.
  
  
  CONCLUSIONS
  Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.
authors: 1 Division of Vascular Medicine and Haemostaseology, Goethe University Hospital, Frankfurt/Main, Germany.
authors: Lea
authors: L
authors: Weingarz
authors: Marc
authors: M
authors: Schindewolf
authors: Jan
authors: J
authors: Schwonberg
authors: Carola
authors: C
authors: Hecking
authors: Zsuzsanna
authors: Z
authors: Wolf
authors: Matthias
authors: M
authors: Erbe
authors: Edelgard
authors: E
authors: Lindhoff-Last
authors: Birgit
authors: B
authors: Linnemann
mesh_terms: D000328:Adult; D000367:Age Factors; D005165:Factor V / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019851:Thrombophilia / Q000097:blood / Q000150:complications*; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology / Q000209:etiology*
chemical_list: C095381:factor V Leiden; D005165:Factor V
keywords: Age; antiphospholipid antibodies; factor VIII; hereditary thrombophilia; recurrent venous thromboembolism