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Factor V Leiden and Prothrombin G20210A Mutations Increase Risk of Central Venous Catheter-Related Thrombosis
A DGReview of :"The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis"
Haematologica
04/01/2004
By Emma Hitt, PhD
Factor V Leiden and prothrombin G20210A mutations contribute significantly to central venous catheter (CVC)-related thrombosis, new research has found.
According to the researchers, a large number of studies have been conducted on the association of factor V Leiden and prothrombin G20210A mutation with deep vein thrombosis and pulmonary embolism, but few studies have investigated the association of these risk factors with CVC-related thrombosis.
In a large hospital population, Cornelis J. Van Rooden, MD, with the Department of General Internal Medicine, Leiden University Medical Center, the Netherlands, and colleagues assessed the incidence of CVC-related thrombosis and the contribution of factor V Leiden and the prothrombin G20210A mutation to this complication.
A total of 252 consecutive patients were monitored every day for thrombosis. Routine Doppler-ultrasound was performed every week in all patients until the CVC was removed. The Doppler measurements were assessed by 2 blinded observers. Factor V Leiden and prothrombin G20210A mutation status and other potential risk factors were assessed in all patients.
Clinical follow-up ended 6 weeks after removal of the CVC, or 1 year after insertion if the CVC was still in place.
The cumulative incidence of-CVC related thrombosis was 30% and was clinically manifested thrombosis in 7%, the researchers report.
Common inherited coagulation disorders and a personal history of thrombosis contributed to CVC-related thrombosis and increased the risk almost 3-fold. The relative risk of factor V Leiden or prothrombin G20210A mutation for thrombosis was 2.7 (CI95% 1.9 to 3.8).
In addition, a personal history of venous thrombosis was associated with CVC-related thrombosis while the severity of thrombosis was affected by the absence of anticoagulants and the presence of cancer.
"Thrombosis frequently occurs after central venous catheterization," Dr. van Rooden and colleagues conclude. "In vulnerable patients, the determination of these factors prior to CVC insertion could help clinicians to decide on anticoagulant prophylaxis," they suggest.
"Future studies are needed to evaluate implementation of preventive strategies, including individual risk-assessment and subsequent anticoagulant prophylaxis of high-risk patients versus long-term routine anticoagulant prophylaxis in all patients," they add.
Haematologica 2004 Feb;89:201-206.
"The contribution of factor V Leiden and prothrombin G20210A mutation to the risk of central venous catheter-related thrombosis"
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