A Study Of The Clinical Characteristics And Prognosis Of Individuals With Venous Thromboembolism Caused By Hereditary Thrombophilia

Objective:Hereditary thrombophilia is a rare cause of venous thromboembolism(VTE),and there is a lack of clinical studies on the particular cause of venous thromboembolism.The purpose of this study is to investigate the differences of VTE in clinical features and long-term prognosis between hereditary thrombophilia and provoked VTE,to screen for risk factors associated with post-thrombotic syndrome in patients with VTE resulting from hereditary thrombophilia,and to provide clinical evidence and recommendations for treatment and health education in patients with hereditary thrombophilia.Methods:Patients in the case group were hospitalized in the Department of Vascular Surgery at Shanxi Bethune Hospital for VTE from January 2017 to December 2019 and tested positive for hereditary thrombophilia,while patients in the control group had provoked VTE and tested negative for thrombophilia between January 2019 and December 2019.Demographics,medical records,acute phase thrombosis-related laboratory findings,and imaging data from both groups were obtained,and the prevalence of post-thrombotic syndrome,clinical outcomes of thrombotic recurrence,and bleeding were followed up for three years.The differences between the two groups were analysed,and the risk factors for post-thrombotic syndrome were established using dichotomous logistic analysis.Results:A total of 201 patients with VTE were included in this study,including 101 patients who tested positive for hereditary thrombophilia test.There are 36 persons for protein C deficiency,55 persons for protein S deficiency,and 10 persons for antithrombin deficiency.The mean age of patients with VTE caused by hereditary thrombophilia was younger than controls(48.1±17.5 vs.58.1±14.1,P<0.05),more males(58,57.4%)than females(43,42.6%),higher levels of D-dimer in the acute phase [2016(3239)ng/ml vs.846(2131)ng/ml,P= 0.001),a higher rate of pulmonary embolism(82.9% vs.35.3%,P<0.001),easy recurrence of thrombosis(37.6% vs.12.0%,P<0.001),and a low rate of post-thrombotic syndrome(16.5% vs.47.5%,P=0.001).According to the ultrasound findings of the deep veins of the lower extremities,it was the femoral,popliteal and posterior tibial venous,as well as the great and small saphenous veins that were more vulnerable to thrombosis in patients with VTE resulting from hereditary thrombophilia(P<0.05).Dichotomous logistic regression analysis suggested that hereditary thrombophilia was not a risk factor for post-thrombotic syndrome in patients with VTE[OR=0.087 95% CI(0.033-0.229),P<0.001].Conclusion:Patients with VTE provoked by hereditary thrombophilia are younger,and have higher D-dimer levels,a higher prevalence of pulmonary embolism,and are prone to recurrent thrombosis than patients with provoked VTE;however,the prevalence of post-thrombotic syndrome is lower than that of patients with provoked VTE.Patients with hereditary thrombophilia are prone to recurrent thrombosis,have a higher thrombotic load,and a lower incidence of post-thrombotic syndrome,which may be related to the prolonged duration of anticoagulation therapy and elastic compression stockings in patients.Treatment of hereditary thrombophilia should focus on prevention of thrombotic recurrence as well as long-term stress therapy.