[Screening for thrombophilic abnormalities in very elderly patients]

Few data are available regarding biological risk factors for venous thromboembolism in the elderly who are at high risk of thrombosis. In the present study, we assessed the prevalence of antithrombin, protein C, protein S deficiency, G1691A factor V Leiden and G20210A prothrombin (FII) gene variant, and antiphospholipid antibodies in patients over 75 years who were referred to us for thrombophilia testing and who presented with unprovoked recurrent venous thromboembolic disease or venous thrombosis at unusual site. Seventy-eight patients, mean aged 86 years, were included in the cohort. No deficiency in natural coagulation inhibitors was found. Ten patients (12.8%) and 6 patients (7.7%) were found heterozygous carriers of the factor V Leiden and of the G20210A FII mutation, respectively. One patient was a double heterozygote. Two patients were diagnosed with antiphospholipid syndrome. These results are discussed along with those obtained in cohorts of elderly patients or in cohorts of younger patients presenting with idiopathic venous thromboembolic disease, either recurrent or not. Our results trend to confirm the recently published French recommendations regarding inherited thrombophilia screening in the elderly: in patients aged 60 years or older, testing should be limited given the weak impact of this finding on the anticoagulation management.