Navegando por Palavras-chave "Venous Thrombosis"
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- ItemEmbargoAvaliação de polimorfismos de genes relacionados à hemostasia e de receptores de estrógeno como fatores de risco para desenvolvimento de trombose venosa cerebral(Universidade Federal de São Paulo (UNIFESP), 2011-02-21) Orikaza, Cristina Mary [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Cerebral venous thrombosis (CVT) is na uncommon disease with some particularities in relation to other-site thrombosis, including a higher frequency in young people, female sex and users of oral contraceptive (OC). Classic inherited risk factors for venous thromboembolism (VTE) and pulmonary embolism (PE) has already been investigated in CVT, yielding some controversial results. Objectives: to investigate in a case-control study the impact of polymorphisms of hemostasis and hormone genes on the risk of CVT in relation to other sites of VTE and of CVT in relation to controls. The polymorphisms included prothrombin mutation G20210A; Factor V Leiden; thrombin-activatable fibrinolysis inhibitor (TAFI) -1053 C/T, -438 G/A, -152 A/G, 505 G/A, 1040 C/T e 1542 C/T; plasminogen activator inhibitor-1 (PAI-1) 4G/5G; factor XIII Val34Leu and estrogen receptors (ER)-ƒÑ (-351A/G e -397 T/C) and ER-ƒÒ 1082 G/A. Patients and controls: the study population was composed of 72 CVT cases (56 women, median age 32.5, range 8-69 years), 128 VTE or PE cases (94 women, median age 38, range 17-70 years) and 143 normal controls (110 women, median age 37, range 18-66 years), sex, age and race matched. Methods: The polymorphisms were detected by PCR technique followed by enzyme digestion or allele-specific PCR. Results: when compared to controls, only prothrombin mutation increased the risk for CVT (OR 7.1; CI 95%: 1.77-28.3) and TEV (OR 5.48; CI 95%: 1.5-20.1). Among women, CVT risk related to prothrombin mutation was no longer significant after adjustment for hormone exposure (OR 0.13; CI 95% 0.02-0.97). Considering only men, the wild haplotype of ER-ƒÑ (351A e 397T) increased CVT risk in comparison to VTE (OR 5.53; CI 95% 1.08 - 28.19). However, due to the large confidence interval, it is necessary to confirm this finding with a higher number of male subjects. TAFI gene haplotypes demonstrated interesting differences in CVT group, with higher presence of cis effect. In cis effect, rare alleles segregate together in the same chromosome, which may cause cumulative effects in a single protein. In order to emphasize this result, it was demonstrated that the presence of wild haplotype TAFI 505G/1040C resulted in a protector effect of CVT compared to control (OR 0.54; CI 95%: 0.03-0.96) and VTE (OR 0.42; CI 95% 0.23-0.76) groups. Conclusions: Prothrombin mutation was a risk factor for CVT and VTE compared to controls. Hormonal exposure seems to modulate CVT risk determined by prothrombin mutation and PAI-1 4G4G. The haplotypes of ER-ƒÑ (351A and 397T) and of TAFI (505G and 1040C) were associated to CVT, increasing or lowering its risk, respectively. The other polymorphisms did not show any influence on CVT and VTE risk in this study population.
- ItemAcesso aberto (Open Access)Avaliação do papel da obesidade e de adipocinas como fatores de risco de Tromboembolismo Venoso: um estudo de casocontrole(Universidade Federal de São Paulo (UNIFESP), 2019-03-18) Pinheiro, Patricia Nunes Bezerra [UNIFESP]; Morelli, Vania Maris [UNIFESP]; http://lattes.cnpq.br/9067828314933870; http://lattes.cnpq.br/9966532300024573; Universidade Federal de São Paulo (UNIFESP)Introduction: The venous thromboembolism (VTE) is a frequent disease related to a relevant morbimortality. The association between obesity and VTE is particularly important due the increased prevalence of obesity in the world. The mechanism that obesity increases the risk of VTE is multifactorial, related probably to the venous stasis, low grade of inflammation, hypercoagulability and hypofibrinolysis. Altering the levels of some adipokines, such as leptin and adiponectin, may be relevant in the mechanism of VTE, as they are able to influence hemostasis. Studies exploring the role of adipokines in the thrombotic risk may contribute to a better understanding of pathophysiology of VTE in obesity. Purpose: To investigate the effect of anthropometric measurements of obesity (body mass index – BMI, waist circumference, hip circumference and hip waist ratio) and the levels of leptin and adiponectin in the risk of VTE. In patients and controls, the relationship between obesity measures and leptin and adiponectin levels, and the correlation of levels of these adipokines with several factors of hemostasis, adhesion molecules and Creactive protein (CRP) were evaluated. Methods: We conducted a case-control study with 85 patients, aged 18-60 years, with a single event of VTE and 120 controls. Patients and controls were matched according to sex and age (± 5 years). Results: The obesity measures were associated with VTE risk, even after the adjusting for potential confounding factors (age, sex, ethnicity, schooling and estrogen use). For example, the BMI ≥30 kg/m2 increased the risk of VTE (Odds ratio 2.33; CI 95% 1.08- 5.01) by approximately 2.5 times the reference (BMI 18.5-24.9 kg/m2). There was no association between leptin or adiponectin levels and thrombotic risk when evaluated as tertiles or continuous variables. Obesity measures positively associated with the leptin levels and negatively with the adiponectin levels in patients and controls. The correlations were weak or absent between levels of adipokines and levels of factors of hemostasis, adhesion molecules and CRP. Conclusions: As expected, obesity was associated with an increased risk of VTE. There was no contribution of leptin or adiponectin levels to the risk of VTE. However, the present results may be used as a source for prospective studies, with larger sample size, and aimed to elucidate the role of adipokines in the risk of VTE.
- ItemSomente MetadadadosValidação externa do escore Villalta traduzido para português brasileiro em pacientes com trombose venosa profunda prévia e sintomas compatíveis com síndrome pós-trombótica(Universidade Federal de São Paulo (UNIFESP), 2021) Avila, Rafael Bernardes De [UNIFESP]; Flumignan, Ronald Luiz Gomes [UNIFESP]; Universidade Federal de São PauloObjective: We sought to systematically translate the Villalta Score from the English language into Brazilian Portuguese, and to assess the external validation when applied to a population with at least 6 months of previous diagnosis of deep vein thrombosis and with compatible symptoms of post-thrombotic syndrome; to compare the ultrasound findings with the severity of post-thrombotic syndrome; and to develop a digital informative application about the post-thrombotic syndrome. Methods: We systematically translated the original Villalta score into Brazilian Portuguese. Fifty participants who underwent two outpatient visits were evaluated using the translated Villalta Score. We assessed its intra-rater and inter-rater agreement, comparing the original Villalta Score versus Brazilian Portuguese Villalta Score; Brazilian Portuguese Villalta Score versus a widely used scale for chronic venous insufficiency, the CEAP clinical component, and the clinical post-thrombotic syndrome severity versus the duplex ultrasonography findings. Results: The intraobserver evaluation of Villalta Score grades had a simple Kappa coefficient of 0.73, and the simple Kappa coefficient interobserver for Villalta Score grades was 0.67. When Villalta Score was compared to CEAP clinical component, it established an excelent Pearson correlation of aproximately 0.9. There was difference among Villalta Score values compared to duplex ultrasonography initial deep vein thrombosis territory, with femoropopliteal showing higher values than distal veins. Higher Villalta Score values were correlated to duplex ultrasonography venous recanalization and reflux. Conclusions: There was a good interobserver and intraobserver agreement when the Brazilian Portuguese Villalta Score was applied; and when compared to CEAP clinical component, Villalta Score showed an excelent correlation. When Villalta Score grading was compared to duplex ultrasonography characteristics, there were statistical and clinical correlation, with presence of reflux and recanalization showing higher Villalta Score values. The application was developed and widely available via the internet.