Predicting Who Is
Vulnerable for Recurrent Blood Clots Getting Closer - The Answer is in
Protein Thrombin Generation - Venous Thrombosis
July 29th 2006
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Australian researchers say that men who have had blood clots have a 50%
higher risk of getting more of them compared to women after finishing
their anti-clotting treatments. There is no difference in risk for men
and women getting a blood clot for the first time, but the research may
help in determining how long patients should be treated for deep venous
thrombosis.
Researchers are still not sure why men are more likely to suffer
multiple blood clots. They speculated that hormonal or genetic factors
may be involved. This research was published in The Lancet.
Research published in the July 26th issue of the Journal of
the American Medical Association (JAMA) could help explain. They say a
test that measures the generation of a certain protein involved with
blood clotting can help determine whether patients who have experienced
a venous blood clot are at low risk of developing another blood clot.
Gregor Hron, M.D., of the Medical University of Vienna, Austria and
colleagues conducted a study to determine whether by measuring thrombin
generation (a protein in blood that causes clotting), patients with
venous thromboembolism (VTE) could be stratified into high and low risk
categories for recurrence of VTE.
Their research concluded that patients without recurrent VTE had lower
thrombin generation than patients with recurrence. The authors wrote
In this large prospective cohort study, we found that patients with a
first spontaneous VTE and peak thrombin generation of less than 400 nM
[the measurement nanomolar] after discontinuation of vitamin K
antagonists have a low risk of recurrence. According to Kaplan-Meier
analysis, the likelihood of recurrent VTE in these patients was as low
as 7 percent after 4 years
Compared with patients who had higher
levels, those with peak thrombin generation less than 400 nM had an
almost 60 percent lower risk of recurrence. Most importantly, the group
of patients with low peak thrombin generation represented two-thirds of
the total patient population.
we believe that our findings are of major clinical relevance. Using
a simple commercially available laboratory method developed to measure
thrombin generation, we were able to identify patients in whom the
long-term risk of recurrent VTE is almost negligible. Considering the
incidence rates of severe or fatal hemorrhage related to anticoagulant
therapy and the case-fatality rate of recurrent VTE, patients with low
peak thrombin generation (less than 400 nM) would almost certainly not
benefit from indefinite anticoagulant therapy. Consequently, extensive
thrombophilia screening appears to be unnecessary in this large,
low-risk patient group, the researchers conclude.
Dan Wilson
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