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The influence of factor V Leiden and G20210A prothrombin mutation on the presence of residual vein obstruction after idiopathic deep-vein thrombosis of the lower limbs

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Highlights from the IVBM 2012

DOI: http://dx.doi.org/10.1160/TH12-01-0041
Issue: 2013: 109/3 (Mar) pp. 361-567
Pages: 510-516

The influence of factor V Leiden and G20210A prothrombin mutation on the presence of residual vein obstruction after idiopathic deep-vein thrombosis of the lower limbs

B. Cosmi (1), C. Legnani (1), V. Pengo (2), A. Ghirarduzzi (3), S. Testa (4), D. Poli (5), D. Prisco (5), A. Tripodi (6), G. Palareti (1), for the PROLONG Investigators (on behalf of FCSA, Italian Federation of Anticoagulation Clinics)

(1) Department of Angiology Blood Coagulation “Marino Golinelli”, University Hospital S. Orsola-Malpighi, Bologna, Italy; (2) Department of Clinical and Experimental Medicine, Division of Clinical Cardiology, University Hospital, Padua Italy; (3) Department of Internal Medicine I, Angiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy; (4) Haemostasis Thrombosis Center, General Hospital, Cremona, Italy; (5) Azienda Ospedaliera di Careggi and Universita’ di Firenze, Florence, Italy; (6) Angelo Bianchi Bonomi Hemophilia Thrombosis Center, Department of Internal Medicine, University IRCCS Maggiore Hospital, Milan, Italy

Keywords

pulmonary embolism, thrombophilia, Deep-vein thrombosis, Venous thrombosis, residual vein obstruction

Summary

It was our aim to assess whether factor V Leiden (FVL) and G20210A prothrombin (FII) mutation are associated with the presence of residual vein obstruction (RVO) after a standard course of anticoagulation for a first episode of idiopathic proximal deep-vein thrombosis (DVT) of the lower limbs, with or without symptomatic pulmonary embolism (PE). Patients were enrolled in two prospective multicentre studies: PROLONG and PROLONG II. RVO was detected by compression ultrasonography according to the method of Prandoni on the day of anticoagulation withdrawal. Patients were also screened for FVL and FII mutation. The presence of FVL and/or FII mutation was determined in 872/963 (90.5%) patients, in 753 of whom RVO was assessed. FVL was significantly less frequent among subjects with isolated PE (7/176:4%) than among patients with either DVT and PE (15/133:11.3%; p=0.0018) or isolated DVT (89/563:15.8%; p<0.0001), confirming the FVL paradox. The rate of FII mutation was similar among patients with isolated PE (11/176:6.2%) and patients with either DVT and PE (12/133:9%) or isolated DVT (52/563:9.2%). FVL and FII mutation were not significantly associated with RVO at the multivariate analysis in all patients, although data suggest that FVL and FII mutation may have a differential effect on RVO in the subgroups of patients with DVT and DVT plus PE patients. Male sex and isolated DVT were significantly associated with RVO in all patients. In conclusion, male sex and isolated DVT are associated with RVO, while FVL and FII mutations are not significantly associated with RVO in this study.

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