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Venous thrombosis is a multi causal disease
Started by N |
Posted: February 9, 2010 at 02:39 | |
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Factor V Leiden is associated with an increased risk of developing an episode of DVT (with or without a PE). Approximately 1 in every 1000 people will develop a DVT or PE each year, and this increases from about 1 in 10 000 for those in their twenties to about 5 in 1000 for those in their seventies. Heterozygous factor V Leiden increases the risk of developing a first DVT by 5- to 7-fold (or 5 to 7 in 1000 people each year). Thus, even though the relative risk of developing a DVT seems high, the absolute risk of having a DVT is still quite low with factor V Leiden. Factor V Leiden is thus a weak risk factor for developing blood clots; in fact, most people who have heterozygous factor V Leiden never develop blood clots. Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. If you have the heterozygous form of factor V Leiden, the lifetime risk of developing a DVT is 10% or less, but may be higher if you have close family members who have had a DVT. Very often, people with factor V Leiden have additional risk factors that contributed to the development of blood clots. Having factor V Leiden alone does not appear to increase the risk of developing thrombosis. Having had a DVT or PE in the past increases your risk for developing another one in the future, but having factor V Leiden does not seem to add to the risk of having a second clot. If you have factor V Leiden but have never had a blood clot, then you will not routinely be treated with an anticoagulant. Rather, you should be counseled about reducing or eliminating other factors that may add to your risk of developing a clot in the future. In addition, you may require temporary treatment with an anticoagulant during periods of particularly high risk, such as major surgery. Factor V Leiden increases the risk of developing a DVT during pregnancy by about 7-fold. Most women with factor V Leiden have normal pregnancies and only require close follow-up during pregnancy. The use of hormones, such as oral contraceptive pills (OCPs) and hormone replacement therapy (HRT, including estrogen and estrogen-like drugs) taken after menopause, increases the risk of developing DVT and PE. Healthy women taking OCPs have a 3- to 4-fold increased risk of developing a DVT or PE compared with women who do not take OCP. Women with factor V Leiden who take OCPs have about a 35-fold increased risk of developing a DVT or PE compared with women without factor V Leiden and those who do not take OCPs. This would translate to an about 35 per 10 000 chance per year of use on average for women in their twenties with factor V Leiden. Likewise, postmenopausal women taking HRT have a 2- to 3-fold higher risk of developing a DVT or PE than women who do not take HRT, and women with factor V Leiden who take HRT have a 15-fold higher risk. This is about a 15 to 40 per 1000 chance per year of use, on average, for women in their fifties with factor V Leiden. 15349
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Re: Venous thrombosis is a multi causal disease
Reply #1 by N |
Posted: February 9, 2010 at 02:40 | |
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Factor V Leiden is only one of many risk factors for the development of DVT or PE. Usually, the effect of risk factors is additive: the more risk factors you have, the higher the risk. Sometimes, however, the effects of multiple risk factors are more than additive. A woman who has factor V Leiden and takes OCPs, for example, has a 35-fold increased risk of developing a DVT, which is higher than the increased risk associated with simply adding together the risk of factor V Leiden (5-fold increased risk) and OCP use (4-fold increased risk). The table lists additional risk factors for developing DVT. Some risk factors, like genetics or age, are not alterable, but many factors can be controlled by medications or lifestyle modifications. For example, obesity is probably the most common modifiable risk factor for developing blood clots, so losing weight (if you are overweight) is an important intervention for risk reduction. Avoiding long periods of immobility is recommended. For example, if you are taking a long car ride (more than 2 hours), then stopping every few hours and walking around for a few minutes is a good way to keep the blood circulating. On long airplane trips, walk in the aisle every so often and prevent dehydration by drinking plenty of fluids and avoiding alcohol. If you have a desk job, get up and walk around the office periodically. If you are hospitalized or require surgery, make sure your doctor knows that you have factor V Leiden so that measures such as the temporary administration of blood thinners may be taken to prevent DVT. Finally, it is important to recognize symptoms of blood clots and seek early medical attention: pain, swelling, and/or redness of a limb or unexplained shortness of breath and/or chest pain are the most common symptoms of DVT and PE. Practical Steps to Minimize Risk * Try to maintain ideal body weight for your sex and height. * Stay active and try to get regular exercise through such activities as walking, bicycling, or swimming. * Avoid prolonged periods of immobility. For example, stop the car, get out, and walk around every few hours during a long trip. On an airplane, drink plenty of water to avoid dehydration, walk the aisles, and avoid alcohol. Wearing elastic stockings with a moderate level of compression (15 to 20 mm Hg) may prevent DVT from developing on long flights. * Don’t smoke. * If you have other chronic medical conditions, such as diabetes, high cholesterol, or congestive heart failure, work with your doctors to try to keep these problems under good control. * Let your doctors know that you have factor V Leiden so that they can administer blood thinners or provide you with mechanical compression boots for your legs if you are hospitalized or need surgery. 15350
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