Database : MEDLINE
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[PMID]: 29099429
[Au] Autor:Leffert L; Butwick A; Carvalho B; Arendt K; Bates SM; Friedman A; Horlocker T; Houle T; Landau R; Dubois H; Fernando R; Houle T; Kopp S; Montgomery D; Pellegrini J; Smiley R; Toledo P; members of the SOAP VTE Taskforce
[Ad] Address:From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Department of Anesthesia, Stanford University School of Medicine, Stanford, California; ‡Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; §Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; and Departments of ‖Obstetrics and Gynecology and ¶Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, United Kingdom Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota Kaiser Permanente Riverside Medical Center, Riverside, California Department of Organizational Systems and Adult Health, Nurse Anesthesia Program, University of Maryland School of Nursing, Baltimore, Maryland Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York; he reports stocks owned by spouse from Abbott Labs, Amgen, and Abbvie, outside of the submitted work Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Title:The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants.
[So] Source:Anesth Analg;, 2017 Nov 01.
[Is] ISSN:1526-7598
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in obstetric patients receiving thromboprophylaxis or higher dose anticoagulants. To date, none of the existing anesthesia societies' recommendations have weighed the potential risks of neuraxial procedures in the presence of thromboprophylaxis, with the competing risks of general anesthesia with a potentially difficult airway, or maternal or fetal harm from avoidance or delayed neuraxial anesthesia. Furthermore, existing guidelines have not integrated the pharmacokinetics and pharmacodynamics of anticoagulants in the obstetric population.The goal of this consensus statement is to provide a practical guide of how to appropriately identify, prepare, and manage pregnant women receiving thromboprophylaxis or higher dose anticoagulants during the ante-, intra-, and postpartum periods. The tactics to facilitate multidisciplinary communication, evidence-based pharmacokinetic and spinal epidural hematoma data, and Decision Aids should help inform risk-benefit discussions with patients and facilitate shared decision making.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher
[do] DOI:10.1213/ANE.0000000000002530

  2 / 26501 MEDLINE  
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[PMID]: 29098438
[Au] Autor:Tao SM; Kong X; Schoepf UJ; Wichmann JL; Shuler DC; Zhou CS; Lu GM; Zhang LJ
[Ad] Address:Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
[Ti] Title:Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study.
[So] Source:Eur Radiol;, 2017 Nov 02.
[Is] ISSN:1432-1084
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To determine whether intravenous iodinated contrast material administration increases the risk of acute kidney injury (AKI) in patients with nephrotic syndrome undergoing contrast-enhanced CT. METHODS: Patients with nephrotic syndrome undergoing contrast-enhanced CT were retrospectively identified (n = 701). Control group consisted of patients with nephrotic syndrome receiving non-contrast CT (n = 1053). Two different 1:1 propensity score matching models using three or 10 variables were developed for each estimated glomerular filtration (eGFR) subgroup. Incidence of post-CT AKI for the two groups was assessed and compared by standard AKI criteria and Acute Kidney Injury Network (AKIN) criteria. RESULTS: After matching with three variables, the AKI incidence in the contrast-enhanced CT and non-contrast CT groups was 2.7% vs 2.5% (standard AKI criteria) and 4.2% vs. 6.7% (AKIN criteria) (p = 1.00 and 0.05), respectively. After matching with 10 variables, AKI incidences were 3.1% vs. 2.6% (standard AKI criteria) and 4.1% vs. 7.4% (AKIN criteria) (p = 0.72 and 0.03), respectively. AKI incidences of each eGFR subgroup in the contrast-enhanced CT group were not higher than in the non-contrast CT group (lowest p = 0.46). CONCLUSION: Intravenous contrast material administration during CT was not found to be a risk factor for AKI in this large cohort of patients with nephrotic syndrome. KEY POINTS: • AKI incidence of contrast-enhanced CT and non-contrast CT had no difference. • AKI incidences of eGFR subgroup in contrast-enhanced CT were not increased. • Studies without a non-contrast CT control group may overestimate CIN incidence.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher
[do] DOI:10.1007/s00330-017-5109-0

  3 / 26501 MEDLINE  
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[PMID]: 29097362
[Au] Autor:Tanratana P; Ellery P; Westmark P; Mast AE; Sheehan JP
[Ad] Address:From the Department of Pathology and Laboratory Medicine (P.T.), Department of Medicine/Hematology-Oncology (P.W., J.P.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand (P.T.); Blood Resea
[Ti] Title:Elevated Plasma Factor IXa Activity in Premenopausal Women on Hormonal Contraception.
[So] Source:Arterioscler Thromb Vasc Biol;, 2017 Nov 02.
[Is] ISSN:1524-4636
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Combined oral contraceptives induce a reversible hypercoagulable state with an enhanced risk of venous thromboembolism, but the underlying mechanism(s) remain unclear. Subjects on combined oral contraceptives also demonstrate a characteristic resistance to APC (activated protein C) in the thrombin generation assay. Here, we report the potential role of plasma factor IXa (FIXa) as a mechanism for hormone-induced systemic hypercoagulability. APPROACH AND RESULTS: A novel assay was used to determine FIXa activity in plasma samples from volunteer blood donors. Plasma from 36 premenopausal females on hormonal contraception and 35 not on hormonal contraception, 35 postmenopausal females, and 10 males were analyzed for FIXa activity, total PS (protein S), total tissue factor pathway inhibitor (TFPI), and TFPI-α antigen. Premenopausal females on hormonal contraception demonstrated significantly increased FIXa activity and decreased TFPI-α compared with the other groups. Remarkably, FIXa values were not normally distributed in the hormonal contraception group, but skewed toward the high end. Plasma FIXa activity inversely correlated with both TFPI-α and total PS antigen. Ex vivo determination of TF-dependent FIX activation in FV-deficient plasma demonstrated that inhibitory anti-TFPI antibodies enhanced FIXa generation by 2- to 3-fold, whereas addition of 75 nmol/L PS reduced FIXa generation by ≈2-fold. Further, increasing FIXa concentration enhanced APC resistance during TF-triggered plasma thrombin generation. CONCLUSIONS: Elevation of plasma FIXa activity in association with reductions in TFPI-α and PS is a potential mechanism for systemic hypercoagulability and resistance to APC in premenopausal females on hormonal contraception.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher

  4 / 26501 MEDLINE  
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[PMID]: 29097174
[Au] Autor:Scovell SD; Ergul EA; Conrad MF
[Ad] Address:Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: sscovell@partners.org.
[Ti] Title:Medical management of acute superficial vein thrombosis of the saphenous vein.
[So] Source:J Vasc Surg Venous Lymphat Disord;, 2017 Oct 30.
[Is] ISSN:2213-3348
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Acute superficial vein thrombosis (SVT) of the axial veins, such as the great saphenous vein (GSV), is a common clinical condition that carries with it significant risk of propagation of thrombus, recurrence, and, most concerning, subsequent venous thromboembolism (VTE). Conservative therapy with nonsteroidal anti-inflammatory medication and heat does not prevent extension of thrombus or protect against recurrent or future VTE in patients with extensive SVT (thrombotic segment of at least 5 cm in length). To prevent future thromboembolic events, anticoagulation has become the treatment of choice for extensive acute SVT in the GSV. In spite of this, the dose and duration of anticoagulation in the treatment of SVT vary widely. This review summarizes the evidence from large prospective, randomized clinical trials on the treatment of SVT with anticoagulation (vs placebo or different doses and durations of anticoagulation) with respect to the outcome measures of thrombus extension, SVT recurrence, and future VTE. METHODS: A systematic search was performed using the MEDLINE database to identify all prospective, randomized controlled trials of treatment with anticoagulation in patients with SVT in the GSV. Six prospective, randomized trials were identified that met the inclusion criteria and were reviewed in detail. RESULTS: Treatment of acute SVT was most commonly managed in an outpatient setting using either low-molecular-weight heparin (LMWH) in four studies or, alternatively, a factor Xa inhibitor in one large multicenter trial. LMWH was associated with a lower rate of thrombus extension and subsequent recurrence, especially when an intermediate dose (defined as a dose between prophylactic and therapeutic doses) was used for a period of 30 days. The full effect of treatment with LMWH on the risk of subsequent VTE remains unclear, as do the optimal dose and duration of this drug. Prophylactic doses of fondaparinux, a factor Xa inhibitor, were found to be beneficial in reducing the rate of thrombus extension and recurrence as well as in reducing the risk of subsequent VTE both during treatment and after cessation of anticoagulation in the short term. CONCLUSIONS: These data suggest that treatment of acute SVT of the GSV with anticoagulation, at doses below therapeutic levels, does offer the benefit of decreased risk of thrombus propagation, recurrence, and, at least in one large randomized clinical trial, subsequent VTE. Future studies to refine optimal dose and duration of anticoagulation to lower the rate of subsequent thromboembolic events and SVT recurrence are needed.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher

  5 / 26501 MEDLINE  
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[PMID]: 29097086
[Au] Autor:Schomburg J; Krishna S; Soubra A; Cotter K; Fan Y; Brown G; Konety B
[Ad] Address:Department of Urology, University of Minnesota, Minneapolis, MN.
[Ti] Title:Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy.
[So] Source:Urol Oncol;, 2017 Oct 30.
[Is] ISSN:1873-2496
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism, is a common cause of morbidity and mortality after radical cystectomy. The purpose of our study was to evaluate the utility of extended outpatient chemoprophylaxis against VTE after radical cystectomy-with a focus on any reduction in the incidence of VTE, including DVT and pulmonary embolism. MATERIALS AND METHODS: Beginning in April 2013, we prospectively instituted a policy of extending inpatient VTE prophylaxis with subcutaneous heparin/enoxaparin for 30 days postoperatively. For this study, we reviewed the electronic medical records of all patients who underwent radical cystectomy at our institution from January 2012 through December 2015. The experimental group (n = 79) received extended outpatient chemoprophylaxis against VTE; the control group (n = 51) received no chemoprophylaxis after discharge. The primary outcome was the 90-day incidence of VTE. The secondary outcomes included the overall complication rate, the hemorrhagic complication rate, as well as the rate of readmission within 30 days of hospital discharge. RESULTS: The experimental group experienced a significantly lower rate of DVT (5.06%), assessed as of 90 days postoperatively, than the control group (17.6%): a relative risk reduction of 71.3% (P = 0.021). We found no significant differences in secondary outcomes between the 2 groups, including the overall complication rate (54.4% vs. 68.6%), the hemorrhagic complication rate (3.7% vs. 2.0%), and the readmission rate (21.5% vs. 29.4%). CONCLUSION: Extended outpatient chemoprophylaxis significantly reduced the incidence of VTE.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher

  6 / 26501 MEDLINE  
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[PMID]: 29096812
[Au] Autor:Weitz JI; Fredenburgh JC; Eikelboom JW
[Ad] Address:Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada. Electronic address: weitzj@taari.ca.
[Ti] Title:A Test in Context: D-Dimer.
[So] Source:J Am Coll Cardiol;70(19):2411-2420, 2017 Nov 07.
[Is] ISSN:1558-3597
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:D-dimer is a soluble fibrin degradation product that results from ordered breakdown of thrombi by the fibrinolytic system. Numerous studies have shown that D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis. Consequently, D-dimer has been extensively investigated for the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and as an aid in the identification of medical patients at high risk for VTE. Thus, quantification of D-dimer levels serves an important role in guiding therapy. This review: 1) describes how D-dimer is generated; 2) reviews the assays used for its detection; and 3) discusses the role of D-dimer determination in these various conditions.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:In-Process

  7 / 26501 MEDLINE  
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[PMID]: 29095762
[Au] Autor:Maral S; Bakanay SM; Dilek I
[Ad] Address:Department of Hematology, Ataturk Training and Research Hospital, Ankara, Turkey.
[Ti] Title:Acquired hemophilia with thrombosis in a cancer patient: an unusual presentation.
[So] Source:Blood Coagul Fibrinolysis;, 2017 Nov 01.
[Is] ISSN:1473-5733
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:: Acquired hemophilia A (AHA) which presents with spontaneous severe intramuscular, mucosal and/or subcutaneous bleeding is a rare bleeding disorder. Even 50% of AHA patients are defined as idiopathic; 10% of cases are related with malignancy. Here, we present a case of AHA in a 43-year-old lady who was diagnosed with malignancy and venous thromboembolism on vena cava 2 years ago. To the best of our knowledge, this is the first report in literature presented with both acquired hemophilia and thrombosis associated with malignancy. A routine workup for malignancy like solid tumors, lymphoproliferative, or myeloproliferative diseases should be performed and followed up for a long time despite clinical improvement for individuals presented with AHA. Moreover, because of warfarin treatment, the diagnosis may be difficult and delayed. Clinicans should rule out AHA in patients who are on warfarin treatment and have abnormal coagulation tests.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[St] Status:Publisher
[do] DOI:10.1097/MBC.0000000000000670

  8 / 26501 MEDLINE  
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[PMID]: 29095189
[Au] Autor:Momeni A; Fox JP
[Ad] Address:From the *Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA; and †Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.
[Ti] Title:Venous Thromboembolism After Surgical Treatment of Breast Cancer.
[So] Source:Ann Plast Surg;, 2017 Oct 31.
[Is] ISSN:1536-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Venous thromboembolism (VTE) remains a serious complication after the surgical treatment of breast cancer. Contemporary guidelines limit VTE chemoprophylaxis to the period of hospitalization. We conducted this study to evaluate the frequency of postdischarge VTE among surgically treated breast cancer patients and identify patient level factors associated with postdischarge VTE. METHODS: Using Arkansas, Florida, Nebraska, and New York state inpatient databases, we conducted a retrospective cohort study of adult women who underwent surgical treatment for breast cancer between October 1, 2008, and September 30, 2013. The primary outcome was a VTE event within 90 days of discharge. Multivariable logistic regression modeling was used to identify patient factors associated with VTE development. RESULTS: The final sample included 52,547 women with most undergoing mastectomy without reconstruction (n = 25,665), followed by mastectomy with implant based reconstruction (n = 16,851), lumpectomy (n = 5319), and mastectomy with autologous reconstruction (n = 4622). There were 395 patients (0.8%) who developed at least 1 VTE. Of the 395 VTEs, 32.9% (n = 130) were identified before discharge, whereas 67.1% were identified within 90 days after discharge. Patients with respiratory disease (adjusted odds ratio [AOR] = 1.56 [1.22-1.98]), hypothyroidism (AOR = 1.31 [1.01-1.70]), a hospital stay of more than 5 days (AOR = 8.07 [5.99-10.89]), previous VTE (AOR = 6.26 [3.95-9.91]), or mastectomy with autologous reconstruction (AOR = 1.50 [1.03-2.19]) more frequently developed postdischarge VTEs. CONCLUSIONS: Nearly two thirds of all 90-day VTE events after breast cancer surgery occur after discharge. Further research should determine whether a longer course of VTE prophylaxis is warranted among specific populations including those with prolonged hospitalizations, previous VTE, and those undergoing autologous reconstruction.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher
[do] DOI:10.1097/SAP.0000000000001249

  9 / 26501 MEDLINE  
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[PMID]: 29094914
[Au] Autor:Petering RC; Brooks NA
[Ad] Address:Oregon Health and Science University, Portland, OR, USA.
[Ti] Title:Testosterone Therapy: Review of Clinical Applications.
[So] Source:Am Fam Physician;96(7):441-449, 2017 Oct 01.
[Is] ISSN:1532-0650
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone. Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia. Depressed mood, fatigue, decreased strength, and a decreased sense of vitality are less specific to male hypogonadism. Testosterone therapy should be initiated only after two morning total serum testosterone measurements show decreased levels, and all patients should be counseled on the potential risks and benefits before starting therapy. Potential benefits of therapy include increased libido, improved sexual function, improved mood and well-being, and increased muscle mass and bone density; however, there is little or mixed evidence confirming clinically significant benefits. The U.S. Food and Drug Administration warns that testosterone therapy may increase the risk of cardiovascular complications. Other possible risks include rising prostate-specific antigen levels, worsening lower urinary tract symptoms, polycythemia, and increased risk of venous thromboembolism. Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop. Testosterone therapy may also be used to treat hypoactive sexual desire disorder in postmenopausal women and to produce physical male sex characteristics in female-to-male transgender patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[St] Status:In-Process

  10 / 26501 MEDLINE  
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[PMID]: 29094466
[Au] Autor:Horvei LD; Braekkan SK; Smith EN; Solomon T; Hindberg K; Frazer KA; Rosendaal FR; Hansen JB
[Ad] Address:K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT -The Arctic University of Norway, Tromsø, Norway.
[Ti] Title:Joint effects of prothrombotic genotypes and body height on the risk of venous thromboembolism: The Tromsø Study.
[So] Source:J Thromb Haemost;, 2017 Nov 02.
[Is] ISSN:1538-7836
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Studies have reported synergistic effects of prothrombotic single nucleotide polymorphisms (SNPs) and obesity on the risk of venous thromboembolism (VTE). Tall stature is associated with increased VTE risk, but the joint effect of prothrombotic genotypes and tall stature on VTE risk is unknown. AIMS: To investigate the joint effects of prothrombotic genotypes and tall stature on the risk of VTE. METHODS: Cases with incident VTE (n=676) and a randomly selected age-weighted subcohort (n=1842) were sampled from the Tromsø study (cohort follow-up: 1994-2012). DNA was genotyped for rs6025 (Factor V Leiden), rs1799963 (Factor 2), rs8176719 (ABO blood group), rs2066865 (Fibrinogen gamma) and rs2036914 (Factor 11). Age- and sex-adjusted hazard ratios (HR) of VTE were calculated by categories of risk alleles (de Haan 5-SNP score; 0-1, 2-3 and ≥4) and body height (<40 , 40-80 and >80 percentile). RESULTS: VTE risk increased by increasing categories of body height, and subjects ≥178 cm had a 2-fold higher VTE risk (HR 2.03; 95% CI 1.51-2.73) than those ≤165 cm. The risk of VTE also increased across categories of risk alleles. However, the combination of a tall stature and risk alleles, either individual SNPs or risk score, did not yield excess VTE risk. Subjects with ≥4 risk alleles and height ≥178 cm had a 2-fold (HR 2.08, 95% CI 1.24-3.52) higher VTE risk than subjects ≤165 cm with 0-1 risk alleles. CONCLUSIONS: In contrast to obesity, presence of prothrombotic genotypes did not yield excess risk of VTE in subjects with a tall stature. This article is protected by copyright. All rights reserved.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[St] Status:Publisher
[do] DOI:10.1111/jth.13892


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