Factor V leiden and morbid obesity in fatal postoperative pulmonary embolism.
Factor V leiden and morbid obesity in fatal postoperative pulmonary embolism.
复制标题
致命性术后肺栓塞中的因子 V leiden 和病态肥胖。
作者：
Hagen Blaszyk;Johannes Bjornsson
假设
目前，临床评估术后急性肺栓塞（APE）的风险。我们假设，在排除已确定的临床危险因素后，对最常见的遗传性血栓形成倾向性凝血缺陷（V 因子 Leiden；R(506)Q）进行昂贵的筛查并不会为手术患者带来额外的益处。
设计
我们回顾了在明尼苏达州罗切斯特市梅奥诊所进行的 8249 例连续尸检的方案和病史。所有在常规手术后死于 APE 且缺乏任何其他 APE 临床危险因素的患者都被纳入其中，并与匹配的对照进行比较。从档案组织中提取基因组 DNA，并通过聚合酶链式反应扩增、限制性酶消化和直接测序来检查 R(506)Q。
结果
急性肺栓塞是 454 名患者（5.5%）的直接死亡原因。其中，32 例 (7.0%) 接受过常规手术。这些患者仅占同期所有病例调整外科手术的不到 0.07%。神经外科手术后 APE 的术后死亡率 (0.3%) 高于所有其他手术 (0.04%)。 16 名患者 (50.0%) 为病态肥胖。仅 1 名患者为 R(506)Q 杂合子，无一人为纯合子。
结论
(1) 致命性 APE 在缺乏临床上明显的静脉血栓栓塞危险因素的手术患者中并不常见。 (2)神经外科患者术后发生APE的风险增加。 (3)病态肥胖是APE术后猝死的主要独立危险因素。 (4) 对于没有临床可识别的血栓栓塞危险因素的手术患者，常规术前筛查 V 因子基因中的 R(506)Q 似乎不会提供额外的益处。
HYPOTHESIS
Currently, the risk for postoperative acute pulmonary embolism (APE) is assessed clinically. We hypothesize that the expensive screening for the most common genetic thrombophilic clotting defect (factor V Leiden; R(506)Q) after exclusion of established clinical risk factors does not offer additional benefit to surgical patients.
DESIGN
We reviewed protocols and histories from 8249 consecutive autopsies performed at the Mayo Clinic, Rochester, Minn. All patients who died of APE after routine surgery and who lacked any other clinical risk factors for APE were included and compared with matched controls. Genomic DNA was extracted from archival tissues and examined for R(506)Q by polymerase chain reaction amplification, restriction enzyme digestion, and direct sequencing.
RESULTS
Acute pulmonary embolism was the immediate cause of death in 454 patients (5.5%). Of those, 32 (7.0%) had undergone routine surgery. These patients represent less than 0.07% of all case-adjusted surgical procedures in the same period. The rate of postoperative death from APE was higher after neurosurgical procedures (0.3%) than all other procedures (0.04%). Sixteen patients (50.0%) were morbidly obese. Only 1 patient was heterozygous and none were homozygous for R(506)Q.
CONCLUSIONS
(1) Fatal APE is uncommon in surgical patients lacking clinically apparent risk factors for venous thromboembolism. (2) Neurosurgical patients are at increased risk for postoperative APE. (3) Morbid obesity is a major independent risk factor in cases of sudden death from APE postoperatively. (4) Routine preoperative screening for R(506)Q in the factor V gene does not appear to offer additional benefit in surgical patients without clinically recognizable thromboembolic risk factor(s).
遗传性血栓形成倾向状态。
DOI：
--
发表时间：
1998
期刊：
Seminars in thrombosis and hemostasis.
影响因子：
--
作者：
Rao,AK;Kaplan,R;Sheth,S
通讯作者：
Sheth,S
影响因子：
120.7
作者：
Allison, DB;Fontaine, KR;VanItallie, TB
通讯作者：
VanItallie, TB