Prevention and treatment of venous thromboembolism - International Consensus Statement (Guidelines according to scientific evidence)

All patients at moderate to high risk for the development of venous thrombo- embolism should receive prophylaxis. The approaches of proven value include low-dose heparin, low molecular weight heparin, oral anticoagulants and intermittent pneumatic compression.

https://journals.sagepub.com/doi/pdf/10.1177/1076029612474840

Prevention and Treatment of Venous Thromboembolism: International Consensus Statement (Guidelines according to scientific evidence)

Thrombosis and disseminated intravascular coagulation are common complications of cancer. Specific conditions associated with cancer such as stasis due to immobilization or blood flow obstruction, surgery, infections, endothelium damage due to chemotherapeutic agents and abnormalities of blood coagulation contribute to the hypercoagulable and thrombophilic state of cancer patients. This procoagulant state in cancer arises mostly from the capacity of tumor cells to express and release procoagulant activities (cancer procoagulant and tissue factor). Decreased levels of inhibitors of coagulation, impaired fibrinolysis, the presence of antiphospholipid antibodies and an acquired activated protein C resistance contribute to the hypercoagulable state. The activation of coagulation is also implicated in tumor proliferation through interactions of coagulation with inflammation and increased tissue factor pathway inhibitor. Laboratory diagnosis of the thrombophilic state include (1) elevation of clotting factors, fibrinogen/fibrin degradation products, hyperfibrinogenemia and thrombocytosis and (2) elevation of specific markers of activation of coagulation: fibrinopeptide A, fragment 1 + 2, thrombin-antithrombin complexes and D-dimers. However, none of the tests has any predictive value for the occurrence of thrombotic events in one individual patient. In patients with venous thromboembolism a noninvasive screening for occult cancer is able to detect a relatively high incidence of hidden cancer and the search for thrombophilia seems important in patients without known cancer.

The thrombophilic state in cancer patients.

SYNDROMES OF THROMBOSIS AND HYPERCOAGULABILITY: Congenital and Acquired Causes of Thrombosis

Objective To provide evidence to support updated guidelines for the management of pregnant women with hereditary thrombophilia in order to reduce the risk of a first venous thromboembolism (VTE) in pregnancy.Design Systematic review and bayesian meta-analysis.Data sources Embase, Medline, Web of Science, Cochrane Library, and Google Scholar from inception through 14 November 2016.Review methods Observational studies that reported on pregnancies without the use of anticoagulants and the outcome of first VTE for women with thrombophilia were eligible for inclusion. VTE was considered established if it was confirmed by objective means, or when the patient had received a full course of a full dose anticoagulant treatment without objective testing. Results 36 studies were included in the meta-analysis. All thrombophilias increased the risk for pregnancy associated VTE (probabilities ≥91%). Regarding absolute risks of pregnancy associated VTE, high risk thrombophilias were antithrombin deficiency (antepartum: 7.3%, 95% credible interval 1.8% to 15.6%; post partum: 11.1%, 3.7% to 21.0%), protein C deficiency (antepartum: 3.2%, 0.6% to 8.2%; post partum: 5.4%, 0.9% to 13.8%), protein S deficiency (antepartum: 0.9%, 0.0% to 3.7%; post partum: 4.2%; 0.7% to 9.4%), and homozygous factor V Leiden (antepartum: 2.8%, 0.0% to 8.6%; post partum: 2.8%, 0.0% to 8.8%). Absolute combined antepartum and postpartum risks for women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutations, or compound heterozygous factor V Leiden and prothrombin G20210A mutations were all below 3%. Conclusions Women with antithrombin, protein C, or protein S deficiency or with homozygous factor V Leiden should be considered for antepartum or postpartum thrombosis prophylaxis, or both. Women with heterozygous factor V Leiden, heterozygous prothrombin G20210A mutation, or compound heterozygous factor V Leiden and prothrombin G20210A mutation should generally not be prescribed thrombosis prophylaxis on the basis of thrombophilia and family history alone. These data should be considered in future guidelines on pregnancy associated VTE risk.

https://www.bmj.com/content/bmj/359/bmj.j4452.full.pdf

Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian meta-analysis.

The diagnostic strategies and clinical characteristics of thrombophilia associated with heterozygous or homozygous factor V Leiden mutation have been determined according to the literature and to a pe

Diagnosis and clinical characteristics of inherited activated protein C resistance.

Objectif: La frequence de la resistance a la proteine C activee (PCa) dans la maladie thrombo-embolique veineuse est encore mal precisee (entre 8,3 et 64 p. 100). Methodes: Nous avons etudie la resistance a la PCa chez 175 patients ayant des antecedents de thromboses veineuses profondes ou superficielles. Le test utilise est fonde sur le temps de coagulation APTT avec et sans PCa. Les resultats sont exprimes en rapport temps avec PCa sur temps sans PCa. Une population-temoin de 50 sujets consideres comme sains a permis de definir la valeur inferieure limite (moyenne des rapports - 2 deviations standard) a 2,!4. Resultats: Nous trouvons 29 patients (soit 17 p. 100) resistants a la PCa selon cette definition. Deux sujets consideres comme sains (4 p, 100) sont resistants a la PCa. Nos resultats ne montrent pas d'influence de l'âge, du sexe sur les resultats de la resistance a la PCa. Les episodes thrombotiques sont essentiellement des thromboses veineuses profondes et/ou des embolies pulmonaires souvent recidivantes et frequemment associees a la prise d'un traitement hormonal ou a la grossesse. Commentaires: En comparant nos resultats avec ceux actuellement publies, 3 a 5 p. 100 des sujets d'une population consideree comme normale et 15 a 25 p. 100 des sujets ayant des antecedents thrombo-emboliques sont resistants a la PCa. La resistance a la PCa semble donc le plus frequent facteur pouvant predisposer aux accidents thrombotiques, comparativement aux autres causes de thrombophilie familiale

Resistance to activated protein C in venous thromboembolic complications. Incidence and clinical manifestations

Le diagnostic biologique de la résistance à la protéine C activée

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Diagnosis and clinical characteristics of inherited activated protein C resistance.

Resistance to activated protein C in venous thromboembolic complications. Incidence and clinical manifestations

Le diagnostic biologique de la résistance à la protéine C activée