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Thrombophilia in non-thrombotic chronic venous disease of the lower limb - a systematic review
Matthew K H Tan1, Sarah Onida1, Michael Laffan2
1Department of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK.
Insights
Thrombophilia, a blood clotting disorder, is linked to non-thrombotic chronic venous disease (CVD). This condition may also lead to an earlier onset of venous disease.
Area of Science:
- Vascular Medicine
- Hematology
Background:
- Chronic venous disease (CVD) poses a substantial public health challenge.
- Thrombophilia is a suspected risk factor, especially for post-thrombotic CVD.
Purpose of the Study:
- To systematically review the association between thrombophilia and non-thrombotic lower limb CVD.
- To investigate the role of thrombophilia in the development of non-thrombotic venous conditions.
Main Methods:
- A systematic review of MEDLINE and Embase databases (1946-March 2018).
- Inclusion of case-control, cohort, and randomized clinical trials on thrombophilias in non-thrombotic CVD.
- Exclusion of non-English studies and post-thrombotic syndrome research.
Main Results:
- Fifteen studies (916 cases, 1261 controls) indicated an association between thrombophilia and non-thrombotic CVD.
- Higher prevalence and altered factor concentrations of thrombophilia were observed in patients.
- Thrombophilia was linked to an earlier onset of CVD, with commoner conditions showing stronger correlations.
Conclusions:
- Thrombophilia is associated with non-thrombotic CVD, though the underlying mechanism remains unclear.
- Causation cannot be definitively established from current evidence.
- Future research should prioritize prospective studies and explore targeted therapies for thrombophilia in CVD management.
Abstract:
Chronic venous disease (CVD) represents a significant healthcare burden. Thrombophilia is proposed as a risk factor, particularly for post-thrombotic CVD. A systematic review was performed to determine the relationship between thrombophilia and non-thrombotic CVD. MEDLINE® and Embase® databases were searched from 1946 up to March 2018. Case-control studies, cohort studies or randomised clinical trials reporting on thrombophilias in non-thrombotic lower limb CVD in adult patients were included. Non-English and post-thrombotic syndrome studies were excluded. Study selection and data extraction were performed by two reviewers. Fifteen studies were included, reporting on 916 cases and 1261 controls. Studies largely focused on venous ulceration and investigated multiple haemostatic factors. An association between thrombophilia and non-thrombotic CVD was identified, with greater prevalence and factor concentration alteration reported in patients compared to controls. Concomitant thrombophilia presence was associated with earlier CVD onset. Relationship strength varied, with commoner aetiologies showing clearer correlation than rarer ones. Thrombophilia is associated with non-thrombotic CVD but the mechanism is unclear and causation cannot be determined. Future research should focus on prospective studies with larger populations and identify adjunct therapies targeting thrombophilia.
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