Contributions
Abstract: PB1822
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
The term 'thrombophilia' means a tendency to thrombosis with an early age onset, family history, severity of thrombosis, disproportionate to the known causative factor and episodes of recurrent thrombosis.
Aims
To examine young patients who had a registered fact of thrombosis of various localization, in the absence of an obvious causative agent, for markers of hematogenous thrombophilia, to assess the possibilities of direct oral anticoagulants for the secondary prevention of thrombus formation.
Methods
Examination of 81 patients (men - 50, women - 31) between the ages of 17 and 45 was carried out. Somatic diseases in which the secondary thrombophilia, complicated by thrombosis may occur were excluded. The age structure of the examined: 5 patients aged 17 - 20 years, 28: 21 - 30, 38: 31 - 40, 10: 41 - 50 years. In 32 patients (38%), the disease debuted with pulmonary embolism; in 11 cases (14%) - ischemic stroke; in 3 (5%) - myocardial infarction; in 35 (43%) - pathology of the veins of the lower extremities. Relapses of vascular complications were already registered in 30 patients at the time of diagnosis.
Results
The following thrombophilia markers were found in 72 patients (men - 43, women - 29): F5 Leiden mutations - in 30 patients, prothrombin F2 G20210A - in 15, MTHFR - in 25, antithrombin III deficiency - in 6 and protein C - in 13, hyperhomocysteinemia - in 30, primary antiphospholipid syndrome (APS) - in 20 patients. In six patients, only one gene mutation took place, in other cases a combined form of thrombophilia was diagnosed. In 55 cases, there was heredity due to pathological thrombus formation.
Acute thrombosis was treated in accordance with national and international guidelines. For the purpose of the secondary prevention of thrombus formation, the drug Dabigatrana etexilate was prescribed to 37 patients; duration of drug administration was from 12 months to 9 years; the dose of the drug was selected individually from 150 to 300 mg per day. The drug Rivaroxaban was prescribed to 25 patients, the duration of drug administration was from 12 months to 6 years; the dose of the drug is 10 - 20 mg per day. The drug Apixaban was prescribed to 10 patients (30 - 50 years old), the duration of drug administration was from 6 months up to 2 years, the dosage - 5-10 mg per day. Only one patient after the administration of Dabigatrana etexilate had a relapse of PE due to low adherence to treatment. The rest had no recurrence of thrombotic complications. No hemorrhagic complications were diagnosed with the use of dabigatran and apixaban. In 5 patients receiving rivaroxaban, there were minor nosebleeds; in three cases they stopped when the dose was reduced from 20 to 15-10 mg, two patients were transferred to dabigatran. No life-threatening bleeding has been reported. Angiovitis was prescribed in case of hyperhomocysteinemia. Replacement therapy was used in the congenital deficiencies of protein C and antithrombin III.
Conclusion
Timely diagnosis of the variant of hematogenous thrombophilia in young patients with thrombosis and the appointment of adequate therapy contribute to the relapse-free course of the disease.
Keyword(s): Prevention, Secondary, Thrombophilia, Thrombosis
Abstract: PB1822
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
The term 'thrombophilia' means a tendency to thrombosis with an early age onset, family history, severity of thrombosis, disproportionate to the known causative factor and episodes of recurrent thrombosis.
Aims
To examine young patients who had a registered fact of thrombosis of various localization, in the absence of an obvious causative agent, for markers of hematogenous thrombophilia, to assess the possibilities of direct oral anticoagulants for the secondary prevention of thrombus formation.
Methods
Examination of 81 patients (men - 50, women - 31) between the ages of 17 and 45 was carried out. Somatic diseases in which the secondary thrombophilia, complicated by thrombosis may occur were excluded. The age structure of the examined: 5 patients aged 17 - 20 years, 28: 21 - 30, 38: 31 - 40, 10: 41 - 50 years. In 32 patients (38%), the disease debuted with pulmonary embolism; in 11 cases (14%) - ischemic stroke; in 3 (5%) - myocardial infarction; in 35 (43%) - pathology of the veins of the lower extremities. Relapses of vascular complications were already registered in 30 patients at the time of diagnosis.
Results
The following thrombophilia markers were found in 72 patients (men - 43, women - 29): F5 Leiden mutations - in 30 patients, prothrombin F2 G20210A - in 15, MTHFR - in 25, antithrombin III deficiency - in 6 and protein C - in 13, hyperhomocysteinemia - in 30, primary antiphospholipid syndrome (APS) - in 20 patients. In six patients, only one gene mutation took place, in other cases a combined form of thrombophilia was diagnosed. In 55 cases, there was heredity due to pathological thrombus formation.
Acute thrombosis was treated in accordance with national and international guidelines. For the purpose of the secondary prevention of thrombus formation, the drug Dabigatrana etexilate was prescribed to 37 patients; duration of drug administration was from 12 months to 9 years; the dose of the drug was selected individually from 150 to 300 mg per day. The drug Rivaroxaban was prescribed to 25 patients, the duration of drug administration was from 12 months to 6 years; the dose of the drug is 10 - 20 mg per day. The drug Apixaban was prescribed to 10 patients (30 - 50 years old), the duration of drug administration was from 6 months up to 2 years, the dosage - 5-10 mg per day. Only one patient after the administration of Dabigatrana etexilate had a relapse of PE due to low adherence to treatment. The rest had no recurrence of thrombotic complications. No hemorrhagic complications were diagnosed with the use of dabigatran and apixaban. In 5 patients receiving rivaroxaban, there were minor nosebleeds; in three cases they stopped when the dose was reduced from 20 to 15-10 mg, two patients were transferred to dabigatran. No life-threatening bleeding has been reported. Angiovitis was prescribed in case of hyperhomocysteinemia. Replacement therapy was used in the congenital deficiencies of protein C and antithrombin III.
Conclusion
Timely diagnosis of the variant of hematogenous thrombophilia in young patients with thrombosis and the appointment of adequate therapy contribute to the relapse-free course of the disease.
Keyword(s): Prevention, Secondary, Thrombophilia, Thrombosis