Female Gender and Resistance to Activated Protein C (FV:Q506) as Potential Risk Factors for Thrombosis after Elective Hip Arthroplasty
Female Gender and Resistance to Activated Protein C (FV:Q506) as Potential Risk Factors for Thrombosis after Elective Hip Arthroplasty
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女性性别和对活化蛋白 C (FV:Q506) 的抵抗是选择性髋关节置换术后血栓形成的潜在危险因素
DOI：
10.1055/s-0038-1657675
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发表时间：
1997
影响因子：
6.7
通讯作者：
B. Dahlbäck
中科院分区：
文献类型：
--
作者：
P. Svensson;G. Benoni;H. Fredin;O. Björgell;P. Nilsson;U. Hedlund;Göran Nylander;D. Bergqvist;B. Dahlbäck
由因子V中的R506 Q突变引起的对活化蛋白C（APC）的抵抗是静脉血栓形成最常见的遗传性危险因素。为了阐明APC抵抗是否是择期全髋关节置换术后静脉血栓形成的危险因素，在随机接受短期（住院期间，n = 100）或长期（住院后3周，n = 98）低分子量肝素（LMWH）预防的患者（n = 198）中研究了APC抵抗（FV：Q506等位基因的存在）与术后血栓形成之间的相关性。在接受短期预防的APC耐药个体中，7/10发生血栓形成，而接受长期预防的2/12发生血栓形成（p <0.0179）。在短期预防组中，APC抵抗和血栓形成之间的关联的优势比为4.2（CI 95% 1.02-17.5）（p <0.0465）。在接受长期预防治疗的患者中，与APC耐药相关的血栓形成发生率没有增加。有两个意想不到的观察结果。一是APC耐药在女性（19/109）比男性（3/89）更常见（p <0.001）。另一个是，即使是没有APC抵抗的女性也比男性更容易发生血栓形成。因此，24/48例FV基因型正常且短期预防的女性发生血栓形成，而男性中为8/42例，p = 0.002。与女性性别和APC耐药性相关的血栓形成风险增加被延长治疗所中和。总之，在接受短期预防的患者中，发现女性是静脉血栓形成的一个强风险因素。尽管APC抵抗似乎是术后血栓形成的一个危险因素，但男性和女性之间APC抵抗的不均匀分布，以及女性血栓形成风险的增加，排除了关于APC抵抗和血栓形成风险增加之间相关性的有效结论。我们的研究结果表明，髋关节手术后长期使用低分子肝素预防对女性比男性更重要。
Summary Resistance to activated protein C (APC) caused by the R506Q mutation in factor V is the most common inherited risk factor for venous thrombosis. To elucidate whether APC-resistance is a risk factor for venous thrombosis after elective total hip replacement, the association between APC-resistance (presence of FV:Q506 allele) and postoperative thrombosis was investigated in patients (n = 198) randomised to received short (during hospitalisation, n = 100) or prolonged prophylaxis (three weeks after hospitalisation, n = 98) with low molecular weight heparin (LMWH). Among APC-resistant individuals receiving short prophylaxis, 7/10 developed thrombosis as compared to 2/12 receiving long prophylaxis (p <0.0179). Odds ratio for association between APC-resistance and thrombosis in the short prophylaxis group was 4.2 (CI 95% 1.02-17.5) (p <0.0465). Among those receiving prolonged, prophylaxis, there was no increased incidence of thrombosis associated with APC-resistance. Two unexpected observations were made. One was that APC-resistance was much more common in women (19/109) than in men (3/89) (p <0.001). The other was that even women without APC-resistance were much more thrombosis-prone than men. Thus, 24/48 of women with normal FV genotype and short prophylaxis developed thrombosis vs 8/42 among men, p = 0.002. The increased risk of thrombosis associated with female gender and APC-resistance was neutralised by the prolonged treatment. In conclusion, among patients receiving short prophylaxis, female gender was found to be a strong risk factor for venous thrombosis. Even though APC-resistance appeared to be a risk factor for postoperative thrombosis, the uneven distribution of APC-resistance between men and women, taken together with the increased risk of thrombosis among women, precluded valid conclusions to be drawn about the association between APC-resistance and an increased risk of thrombosis. Our results suggest that prolonged prophylaxis with LMWH after hip surgery is more important for women than for men.