Factor V Leiden
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Activated Protein C Resistance: the Most Common Risk Factor for Venous Thromboembolism
J Am Board Fam Pract: first published as 10.3122/15572625-13-2-111 on 1 March 2000. Downloaded from CLINICAL REVIEW Activated Protein C Resistance: The Most Common Risk Factor for Venous Thromboembolism Dawn R. Sheppard, DO Background: Venous thromboembolism is a major cause of morbidity and mortality. Although activated protein C resistance (APC-R) is the most commonly recognized inherited risk factor for venous throm boembolism, little is known about its long-tenn implications on health. Methods: MEDLINE was searched from January 1989 through August 1999 using the key words ''thromboembolism," ''thrombosis," "activated protein C resistance," and "factor V Leiden." Results: One in 1000 people in the United States is affected by venous thromboembolism annually. APC-R is now understood to be responsible for up to 64% of these cases. APC-R, which occurs widely in some ethnic groups and is nearly absent in others, is due to a single point mutation in the gene for clot ting factor V. As a result, inactivation of factor V by activated protein C is impaired, leading to a hyper coagulable state. This condition creates a lifelong increased risk of thrombosis and, possibly, anticoag- ulant therapy.. Conclusion: Family physicians have a new tool for assessing risks for venous thromboembolism. Recognizing that up to 64% of patients with venous thromboembolism can have APe-R and treating this disorder with prophylactic and therapeutic anticoagulation might reduce patient morbidity and mortal ity from venous thromboembolism. Screening high-risk patients might now be indicated. (J Am Board Fam Pract 2000i13:111-5.) Venous thromboembolism, a serious health prob "thromboembolism," "thrombosis," "activated pro lem and an important cause of morbidity, affects tein C resistance," and "factor V Leiden." about 1 in 1000 persons annually. -
Familial Multiple Coagulation Factor Deficiencies
Journal of Clinical Medicine Article Familial Multiple Coagulation Factor Deficiencies (FMCFDs) in a Large Cohort of Patients—A Single-Center Experience in Genetic Diagnosis Barbara Preisler 1,†, Behnaz Pezeshkpoor 1,† , Atanas Banchev 2 , Ronald Fischer 3, Barbara Zieger 4, Ute Scholz 5, Heiko Rühl 1, Bettina Kemkes-Matthes 6, Ursula Schmitt 7, Antje Redlich 8 , Sule Unal 9 , Hans-Jürgen Laws 10, Martin Olivieri 11 , Johannes Oldenburg 1 and Anna Pavlova 1,* 1 Institute of Experimental Hematology and Transfusion Medicine, University Clinic Bonn, 53127 Bonn, Germany; [email protected] (B.P.); [email protected] (B.P.); [email protected] (H.R.); [email protected] (J.O.) 2 Department of Paediatric Haematology and Oncology, University Hospital “Tzaritza Giovanna—ISUL”, 1527 Sofia, Bulgaria; [email protected] 3 Hemophilia Care Center, SRH Kurpfalzkrankenhaus Heidelberg, 69123 Heidelberg, Germany; ronald.fi[email protected] 4 Department of Pediatrics and Adolescent Medicine, University Medical Center–University of Freiburg, 79106 Freiburg, Germany; [email protected] 5 Center of Hemostasis, MVZ Labor Leipzig, 04289 Leipzig, Germany; [email protected] 6 Hemostasis Center, Justus Liebig University Giessen, 35392 Giessen, Germany; [email protected] 7 Center of Hemostasis Berlin, 10789 Berlin-Schöneberg, Germany; [email protected] 8 Pediatric Oncology Department, Otto von Guericke University Children’s Hospital Magdeburg, 39120 Magdeburg, Germany; [email protected] 9 Division of Pediatric Hematology Ankara, Hacettepe University, 06100 Ankara, Turkey; Citation: Preisler, B.; Pezeshkpoor, [email protected] B.; Banchev, A.; Fischer, R.; Zieger, B.; 10 Department of Pediatric Oncology, Hematology and Clinical Immunology, University of Duesseldorf, Scholz, U.; Rühl, H.; Kemkes-Matthes, 40225 Duesseldorf, Germany; [email protected] B.; Schmitt, U.; Redlich, A.; et al. -
Regulation of Coagulation by the Fibrinolytic System: Expecting the Unexpected
Bleeding disorders Regulation of coagulation by the fibrinolytic system: expecting the unexpected K.A. Hajjar ABSTRACT Department of Cell and Recent investigations into fibrinolysis and coagulation have yielded exciting and unexpected findings. Developmental Biology, Of note, deficiencies of the major components of the classical fibrinolytic system, namely plasminogen, Department of Pediatrics tissue plasminogen activator, and urokinase, are now recognized to be rare causes of macrovascular Department of Medicine, thrombosis. At the same time, both plasminogen activator excess and fibrinolytic inhibitor deficiencies Weill Cornell Medical College, are associated with clinically significant bleeding, while elevated inhibitor levels, particularly thrombin New York, New York, USA activatable fibrinolysis inhibitor, appear to confer clinically significant risk for thrombosis. Receptor- mediated cell surface fibrinolysis adds a new dimension to the regulation of fibrin balance. Exaggerated expression of the annexin A2 complex, for example, is associated with hemorrhage in acute promyelo- Hematology Education: cytic leukemia, whereas autoantibodies directed against A2 correlate with thrombotic disease in the education program for the patients with antiphospholipid syndrome. The contributions of the urokinase receptor and a diverse annual congress of the European array of plasminogen receptors to fibrin homeostasis remain to be defined. Future studies are likely to Hematology Association reveal novel mechanisms that co-regulate coagulation and -
Alpha-Dystroglycan Plays Functional Roles in Platelet Aggregation and Thrombus Growth
Alpha-dystroglycan plays functional roles in platelet aggregation and thrombus growth by Reid Gallant A thesis submitted in conformity with the requirements For the degree of Master of Science Graduate Department of Laboratory Medicine and Pathobiology University of Toronto © Copyright by Reid Gallant 2017 i Alpha-dystroglycan Plays Functional Roles in Platelet Aggregation and Thrombus Growth Reid Gallant Master of Science Department of Laboratory Medicine and Pathobiology University of Toronto 2017 ABSTRACT Fibrinogen (Fg) and von Willebrand factor (VWF) have been considered essential for platelet adhesion and aggregation. However, platelet aggregation still occurs in mice lacking Fg and/or VWF but not β3 integrin, suggesting other, unidentified αIIbβ3 integrin ligand(s) mediate platelet aggregation. Through screening published platelet proteomics data, we identified a candidate, alpha-dystroglycan (α-DG). Using Western blot and flow cytometry, I found α-DG is expressed on platelets. Using aggregometry, I observed that antibodies against α-DG or its N- terminal Laminin-binding site, decreased platelet aggregation induced by various platelet agonists in both platelet-rich plasma and gel-filtered platelets. These antibodies also decreased platelet adhesion/aggregation in perfusion chambers independent of α-DG-Laminin interaction. Using laser injury intravital microscopy and carotid artery thrombosis models, we further found that these anti-α-DG antibodies decreased thrombus growth in vivo. Our results showed that α- DG may form an α-DG-fibronectin complex that binds to αIIbβ3 integrin, contributing to platelet adhesion/aggregation, and thrombosis growth. ii Acknowledgements ―It helps a man immensely to be a bit of a hero-worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies‖ – Sir William Osler I will always be grateful to my MSc supervisor, Dr. -
The Approach to Thrombosis Prevention Across the Spectrum of Philadelphia-Negative Classic Myeloproliferative Neoplasms
Review The Approach to Thrombosis Prevention across the Spectrum of Philadelphia-Negative Classic Myeloproliferative Neoplasms Steffen Koschmieder Department of Medicine (Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation), Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, D-52074 Aachen, Germany; [email protected]; Tel.: +49-241-8080981; Fax: +49-241-8082449 Abstract: Patients with myeloproliferative neoplasm (MPN) are potentially facing diminished life expectancy and decreased quality of life, due to thromboembolic and hemorrhagic complications, progression to myelofibrosis or acute leukemia with ensuing signs of hematopoietic insufficiency, and disturbing symptoms such as pruritus, night sweats, and bone pain. In patients with essential thrombocythemia (ET) or polycythemia vera (PV), current guidelines recommend both primary and secondary measures to prevent thrombosis. These include acetylsalicylic acid (ASA) for patients with intermediate- or high-risk ET and all patients with PV, unless they have contraindications for ASA use, and phlebotomy for all PV patients. A target hematocrit level below 45% is demonstrated to be associated with decreased cardiovascular events in PV. In addition, cytoreductive therapy is shown to reduce the rate of thrombotic complications in high-risk ET and high-risk PV patients. In patients with prefibrotic primary myelofibrosis (pre-PMF), similar measures are recommended as in those with ET. Patients with overt PMF may be at increased risk of bleeding and thus require a more individualized approach to thrombosis prevention. This review summarizes the thrombotic Citation: Koschmieder, S. The risk factors and primary and secondary preventive measures against thrombosis in MPN. Approach to Thrombosis Prevention across the Spectrum of Keywords: myeloproliferative neoplasms (MPN); polycythemia vera (PV); essential thrombocythemia Philadelphia-Negative Classic (ET); primary myelofibrosis (PMF); thrombosis; prevention; antiplatelet agents; anticoagulation; cy- Myeloproliferative Neoplasms. -
Thrombosis in the Antiphospholipid Syndrome
Thrombosis in the antiphospholipid syndrome Reyhan D‹Z KÜÇÜKKAYA Division of Hematology, Department of Internal Medicine, Istanbul University, Istanbul School of Medicine, Istanbul, TURKEY Turk J Hematol 2006;23(1): 5-14 INTRODUCTION her autoimmune disorders, especially with systemic lupus erythematosus (SLE)[8]. Besi- Antiphospholipid antibodies (aPLA) are des these autoimmune conditions, aPLA may heterogenous antibodies directed against be present in healthy individuals, in patients phospholipid–protein complexes. Antiphosp- with hematologic and solid malignancies, in holipid syndrome (APS) is diagnosed when ar- patients with certain infections [syphilis, lep- terial and/or venous thrombosis or recurrent rosy, human immunodeficiency virus (HIV), fetal loss occurs in a patient in whom scre- cytomegalovirus (CMV), Epstein-Barr virus ening for aPLA are positive. Because both (EBV), etc.], and in patients being treated thrombosis and fetal loss are common in the with some drugs (phenothiazines, procaina- population, persistent positivity of aPLA is mide, phenytoin etc.). Those antibodies are important. This syndrome is predominant in defined as “alloimmune aPLA”, and they are females (female to male ratio is 5 to 1), espe- generally transient and not associated with cially during the childbearing years[1-7]. the clinical findings of APS[9]. A minority of As in the other autoimmune disorders, APS patients may acutely present with mul- aPLA and APS may accompany other autoim- tiple simultaneous vascular occlusions affec- mune diseases and certain situations. APS is ting small vessels predominantly, and this is referred to as “primary” when it occurs alone termed as “catastrophic APS (CAPS)”[1-7]. or “secondary” when it is associated with ot- Milestones in the Antiphospholipid Syndrome History Antifosfolipid sendromu The first antiphospholipid antibodies we- Anahtar Kelimeler: Antifosfolipid sendromu, Antifosfolipid re discovered by Wasserman et al.[10] in antikorlar, Tromboz. -
Factor V Leiden Thrombophilia
Factor V Leiden thrombophilia Description Factor V Leiden thrombophilia is an inherited disorder of blood clotting. Factor V Leiden is the name of a specific gene mutation that results in thrombophilia, which is an increased tendency to form abnormal blood clots that can block blood vessels. People with factor V Leiden thrombophilia have a higher than average risk of developing a type of blood clot called a deep venous thrombosis (DVT). DVTs occur most often in the legs, although they can also occur in other parts of the body, including the brain, eyes, liver, and kidneys. Factor V Leiden thrombophilia also increases the risk that clots will break away from their original site and travel through the bloodstream. These clots can lodge in the lungs, where they are known as pulmonary emboli. Although factor V Leiden thrombophilia increases the risk of blood clots, only about 10 percent of individuals with the factor V Leiden mutation ever develop abnormal clots. The factor V Leiden mutation is associated with a slightly increased risk of pregnancy loss (miscarriage). Women with this mutation are two to three times more likely to have multiple (recurrent) miscarriages or a pregnancy loss during the second or third trimester. Some research suggests that the factor V Leiden mutation may also increase the risk of other complications during pregnancy, including pregnancy-induced high blood pressure (preeclampsia), slow fetal growth, and early separation of the placenta from the uterine wall (placental abruption). However, the association between the factor V Leiden mutation and these complications has not been confirmed. Most women with factor V Leiden thrombophilia have normal pregnancies. -
Factor V Leiden Thrombophilia Jody Lynn Kujovich, MD
GENETEST REVIEW Genetics in Medicine Factor V Leiden thrombophilia Jody Lynn Kujovich, MD TABLE OF CONTENTS Pathogenic mechanisms and molecular basis.................................................2 Obesity ...........................................................................................................8 Prevalence..............................................................................................................2 Surgery...........................................................................................................8 Diagnosis................................................................................................................2 Thrombosis not convincingly associated with Factor V Leiden....................8 Clinical diagnosis..............................................................................................2 Arterial thrombosis...........................................................................................8 Testing................................................................................................................2 Myocardial infarction.......................................................................................8 Indications for testing......................................................................................3 Stroke .................................................................................................................8 Natural history and clinical manifestations......................................................3 Genotype-phenotype -
Digestive Hemorrhaging in a Patient Being Treated with Anticoagulants
Clinical problem Digestive hemorrhaging in a patient being treated with anticoagulants Alberto Rodríguez Varón, MD,1 Edward A. Cáceres-Méndez, MD.2 1 Professor of Internal Medicine and Gastroenterology. CliniCal Case Pontificia Universidad Javeriana. Hospital Universitario San Ignacio. Bogotá 2 Medical Intern, Pontificia Universidad Javeriana. Hospital Universitario San Ignacio. Bogotá The patient was a sixty-five-year-old male with continuous abdominal pain on the left side which had been developing for 12 hours. Towards the end of that period, the ......................................... Received: 09-02-11 patient showed melanemesis, rectal bleeding, hematuria, whimpering, and rectal and Accepted: 22-02-11 bladder tenesmus. An important event in this patient’s background was ischemic heart disease with myocardial revascularization. A coronary stent had been placed six months before. His condition was being dealt with through dual antiplatelet therapy. He had also presented a deep vein thrombosis with pulmonary embolism three months before. Since then, he had been anticoagulated with low molecular weight heparin and warfarin with irregular monitoring. He was also taking metoprolol, enalapril, and lovastatin. He presented chronic alcohol consumption. At the time he was admitted to the hospital, his blood pressure was 130/80 mm Hg and his heart rate was 54 beats per minute. He was sleepy but did not have any other neurological symptoms. There were no cirrhotic or portal hypertension stigmas. His jugular venous distension was level II and his heart beat and respiratory sounds were normal. The abdomen was soft, without pain, and his intestinal sounds were normal. His symmetrical peripheral pulses were also normal. The patient was hospitalized with a diagnosis of over coagulation, upper and lower gastrointestinal bleeding, and possible urolithiasis. -
Prevalence of Genetic Thrombophilia in Primary Antiphospholipid Syndrome
European Review for Medical and Pharmacological Sciences 2021; 25: 3645-3646 Prevalence of genetic thrombophilia in primary antiphospholipid syndrome Dear Editor, Primary antiphospholipid syndrome (pAPS) is characterized by thrombotic events and preg- nancy losses associated with the presence of antiphospholipid antibodies. The combination of two or more thrombophilic factors increases the risk of thrombosis1-5. The present study aimed to assess the prevalence of other genetic or acquired thrombophilic factors in pAPS and verify whether there is a relevant clinical association. We investigated a cohort of 62 patients (88.9% women; mean age: 39.3 years) diagnosed with pAPS (Sapporo criteria), the presence of other thrombophilic factors, namely: hyperhomocysteinemia (HH) by chemiluminescence method; protein S deficiency (DPS) through functional quantification by chronometric method; protein C (DPC) and antithrombin III (ATIII) deficiencies through functional quantification by the chromo- genic substrate; and the search for the G20210A mutation of the prothrombin gene (MGP) by polymerase chain reaction (PCR), followed by digestion with Hind III restriction enzyme and the search for the Q506 mutation of the factor V gene (Leiden factor V - LFV), by PCR followed by digestion with restriction enzyme Mnl I. Three (19%) patients with LFVL in heterozygous form were found in 16 surveyed. HH was found in 2/40 (5%); 1/31 FVDATIII (3.2%); DPC at 7/33 (21%); and DPS at 8/32 (32%). No MGP was found in the 14 patients in which it was searched. It was also found that when comparing the groups of isolated APS with those of combined APS with thrombophilia factors, it was found that the age of the first presentation of thrombosis or pregnancy loss was significantly lower in the isolated APS group (30.4 vs. -
Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents Partha Pal, Manu Tandan, Duvvuru Nageshwar Reddy
Published online: 2019-09-16 Review Article Risk of Gastrointestinal Bleed and Endoscopic Procedures on Antiplatelet and Antithrombotic Agents Partha Pal, Manu Tandan, Duvvuru Nageshwar Reddy Department of Medical The use of antiplatelet and antithrombotic agents has increased hand in hand with Gastroenterology, Asian the number and complexity of endoscopic procedures. Hence, the endoscopists Institute of Gastroenterology, Hyderabad, Telangana, India are often faced with considering endoscopy in patients on these agents. In this setting, to make informed decision, four key aspects are need to be considered. Abstract The type of antithrombotic or antiplatelet agent used and its characteristics, risk of thromboembolic events (which can lead to ischemic stroke or acute coronary syndrome, both of which carry high morbidity) due to withholding the drug, risk of bleeding (increases with invasiveness of procedure), and timing of procedure (elective or urgent) are the key factors to consider. We aim to discuss the risk of gastrointestinal bleed and endoscopic procedures on antiplatelet and antithrombotic agents focusing on Indian context based on recent Asia‑pacific guidelines along with other existing guidelines. Keywords: Antiplatelets, antithrombotic agents, endoscopy, gastrointestinal bleeding Introduction is taking. The knowledge of mechanism of action, astrointestinal (GI) bleed is one of the most onset and offset of action, pharmacokinetics, drug common medical emergencies in day‑to‑day interactions, and risk of bleeding with each agent is G essential for periendoscopic management of patients practice. With increase in age and comorbidities, on antiplatelet or antithrombotic agents. The timing of the use of antithrombotic agents (antiplatelet and discontinuation before endoscopy and resumption after anticoagulant agents) is widely prevalent, and this endoscopic hemostasis is discussed in detail later in the has added an additional dimension in the management manuscript. -
Congenital Thrombophilia
Congenital thrombophilia The term congenital thrombophilia covers a range of Factor V Leiden and pregnancy conditions that are inherited by someone at birth. This means It is important that women with Factor V Leiden who are that their blood is sticker than normal, which increases the pregnant discuss this with their obstetrician as they have an risk of blood clots and thrombosis. increased risk of venous thrombosis during pregnancy. Some Factor V Leiden and Prothrombin 20210 are the most evidence suggests that they may also have a slightly higher common thrombophilias among people of European origin. risk of miscarriage and placental problems. Other congenital thrombophilias include Protein C Deficiency, Protein S Deficiency, and Antithrombin Deficiency. Prothrombin 20210 Prothrombin is one of the blood clotting factors. It circulates Factor V Leiden in the blood and when activated, is converted to thrombin. Factor V Leiden is by far the most common congenital Thrombin causes fibrinogen, another clotting factor, to thrombophilia. In the UK it is present in 1 in 20 individuals of convert to fibrin strands, which make up part of a clot. European origin. It is rare in people of Black or Asian origin. The condition known as Prothrombin 20210 is due to a Factor V Leiden is caused by a change in the gene for Factor mutation of the prothrombin gene. Individuals with the V, which helps the blood to clot. To stop a clot spreading a condition tend to have slightly stickier blood, due to higher natural blood thinner, known as Protein C, breaks down prothrombin levels. Factor V.