Venous thromboembolism in Asia – an unrecognised and under-treated problem?

Pantep Angchaisuksiri

doi:10.1160/TH11-03-0184

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(04): 585-590
DOI: 10.1160/TH11-03-0184

Invited Clinical Focus

Schattauer GmbH

Venous thromboembolism in Asia – an unrecognised and under-treated problem?

Pantep Angchaisuksiri

¹Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

› Author Affiliations

Abstract

Summary

Venous thromboembolism (VTE) has been perceived for a long time to be less common in Asian populations, particularly in the Far East, than in Western populations. Generally, thromboprophylaxis is not implemented as frequently as it should be in high-risk patients. However, recent prospective studies undertaken in Asian countries have demonstrated higher rates of VTE after major surgery and in medical wards, approaching those observed in Western populations. Risk factors for VTE are not different in Asian patients from those of Western patients with the exception of thrombophilic mutations. Deficiencies of the natural anticoagulants (protein S, protein C, and antithrombin) are the predominant thrombophilias in Asia whereas factor V Leiden and prothrombin G20210A gene mutation are not found or rarely reported. Further large well-designed clinical studies are needed to evaluate the magnitude of the risk of VTE and the appropriate use of thromboprophylaxis in different clinical situations.

Keywords

Venous thromboembolism - Asia - Far East

Full Text

References

References
1 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8^th Edition). Chest 2008; 133 (Suppl) 381S-453S.
2 Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program 2010; 216-220.
3 Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2011; 364: 351-360.
4 Cohen AT, Tapson VF, Bergmann JF. et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387-394.
5 Hwang WS. The rarity of pulmonary thromboembolism in Asians. Singapore Med J 1968; 9: 276-279.
6 Chumnijarakij T, Poshyachinda V. Post-operative thrombosis in Thai women. Lancet 1975; 1: 1357-1358.
7 Nandi P, Wong KP, Wei WI. et al. Incidence of post operative deep vein thrombosis in Hong Kong Chinese. Br J Surg 1980; 67: 251-253.
8 Inada K, Shirai N, Hayashi M. et al. Postoperative deep venous thrombosis in Japan. Incidence and prophylaxis. Am J Surg 1983; 145: 775-779.
9 Atichartakarn V, Pathepchotiwong K, Eurvilaichit C. Deep vein thrombosis after hip surgery among Thai. Arch Intern Med 1988; 148: 1349-1353.
10 Stein PD, Kayali F, Olson RE. et al. Pulmonary thromboembolism in Asians/ Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. Am J Med 2004; 116: 435-442.
11 White RH, Zhou H, Murin S. et al. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 2005; 93: 298-305.
12 Schneider D, Lillenfield DE, Im W. The epidemiology of pulmonary embolism: racial contrasts in incidence and in-hospital case fatality. J Natl Med Assoc 2006; 98: 1967-1972.
13 Leizorovicz A, Turpie AGG, Cohen AT. et al. Epidemiology of post-operative venous thromboembolism in Asian countries. Int J Angiol 2004; 13: 101-108.
14 Leizorovicz A, Turpie AGG, Cohen AT. et al. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost 2005; 3: 28-34.
15 Leizorovica A. on behalf of the SMART Venography Study Steering Committee. Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study. Haematologica 2007; 92: 1194-200.
16 Piovella F, Wang C-J, Lu H. et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost 2005; 3: 2664-2670.
17 Sakon M, Maehara Y, Yoshikawa H. et al. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost 2006; 4: 581-586.
18 Cheng Y, Wong R, Lam J. et al. Estimated risk of deep venous thrombosis among Chinese patients admitted to general medical wards. J Thromb Haemost 2004; 2: 1666-1668.
19 Leung V, Leung V, Lui W. et al. Incidence of deep vein thrombosis in hospitalized Chinese medical patients is similar to that in western populations. Thromb Res 2006; 118: 763-764.
20 Ng HJ, Lee LH. Trends in prevalence of deep venous thrombosis among hospitalized patients in an Asian institution. Thromb Haemost 2009; 101: 1095-1099.
21 Aniwan S, Rojnuckarin P. High incidence of symptomatic venous thromboembolism in Thai hospitalized medical patients without thromboprophylaxis. Blood Coagul Fibrinolysis 2010; 21: 334-338.
22 Jang MJ, Bang S-M, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9: 85-91.
23 Liu YEB, Hu S, Chan SP. et al. The epidemiology and surgical outcomes of patients undergoing primary total hip replacement: an Asian perspective. Singapore Med J 2009; 50: 15-19.
24 Samama CM, Clergue F, Barre J. et al. Low molecular weight heparin associated with spinal anaesthesia and gradual compression stockings in total hip replacement surgery. Br J Anaesth 1997; 78: 660-665.
25 Leclerc JR, Geerts WH, Desjardins L. et al. Prevention of deep vein thrombosis after major knee surgery – a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost 1992; 67: 417-423.
26 Agnelli G, Cosmi B, Filippo PD. et al. A randomised, double-blind, placebo-controlled trial of dermatan sulphate for prevention of deep vein thrombosis in hip fracture. Thromb Haemost 1992; 67: 203-208.
27 Ockelford PA, Patterson J, Johns AS. A double-blind randomized placebo controlled trial of thromboprophylaxis in major elective general surgery using once daily injections of a low molecular weight heparin fragment (Fragmin). Thromb Haemost 1989; 62: 1046-1049.
28 Alikhan R, Peters F, Wilmott R. et al. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol 2004; 57: 1254-1257.
29 Dunn AS, Brenner A, Halm EA. The magnitude of an iatrogenic disorder: a systematic review of the incidence of venous thromboembolism for general medical inpatients. Thromb Haemost 2006; 95: 758-762.
30 Cohen AT. on behalf of the Asia-Pacific Thrombosis Advisory Board. Asia-Pacific Thrombosis Advisory Board consensus paper on prevention of venous thromboembolism after major orthopaedic surgery. Thromb Haemost 2010; 104: 919-930.
31 Seligsohn U, Lubetsky A. Genetic susceptibility to venous thrombosis. N Engl J Med 2001; 344: 1222-1231.
32 Margaglione M, Grandone E. Population genetics of venous thromboembolism. Thromb Haemost 2011; 105: 221-231.
33 Angchaisuksiri P, Pingsuthiwong S, Aryurachai K. et al. Prevalence of the G1691A mutation in the factor V gene (factor V Leiden) and the G20210A prothrombin gene mutation in the Thai population. Am J Hematol 2000; 65: 119-122.
34 Lu Y, Zhao Y, Liu G. et al. Factor V gene G1691A mutation, prothrombin gene G20210A mutation, and MTHFR gene C677T mutation are not risk factors for pulmonary thromboembolism in Chinese population. Thromb Res 2002; 106: 7-12.
35 Takamiya O, Ishida F, Kodaira H. et al. APC-resistance and Mnl1 genotype (Gln 506) of coagulation factor V are rare in Japanese population. Thromb Haemost 1995; 74: 996.
36 Miyata T, Kawasaki T, Fujimura H. et al. The prothrombin gene G20210A mutation is not found among Japanese patients with deep vein thrombosis and healthy individuals. Blood Coagul Fibrinolysis 1998; 9: 451-452.
37 Angchaisuksiri P, Atichartakarn V, Aryurachai K. et al. Risk factors of Thai patients with venous thromboembolism. Int J Hematol 2007; 86: 397-402.
38 Chen TY, Su WC, Tsao CJ. Incidence of thrombophilia detected in southern Taiwanese patients with venous thrombosis. Ann Hematol 2003; 82: 114-117.
39 Miyata T, Sato Y, Ishikawa J. et al. Prevalence of genetic mutations in protein S, protein C and antithrombin genes in Japanese patients with deep vein thrombosis. Thromb Res 2009; 124: 14-18.
40 Suehisa E, Nomura T, Kawasaki T. et al. Frequency of natural coagulation inhibitor (antithrombin III, protein C and protein S) deficiencies in Japanese patients with spontaneous deep vein thrombosis. Blood Coagul Fibrinolysis 2001; 12: 95-99.
41 Akkawat B, Rojnuckarin P. Protein S deficiency is common in a healthy Thai population. J Med Assoc Thai 2005; 88 (Suppl. 04) S249-S254.
42 Zhu T, Ding Q, Bai X. et al. Normal ranges and genetic underlying variants of anti-thrombin, protein C and protein S in the general Chinese population. Results of the Chinese Hemostasis Investigation on Natural Anticoagulants Study I Group. Haematologica 2011; 96: 1033-1040.
43 Miyata T, Kimura R, Kokubo Y. et al. Genetic risk factors for deep vein thrombosis among Japanese: importance of protein S K196E mutation. Int J Hematol 2006; 83: 217-223.
44 Castoldi E, Rosing J. APC resistance: biological basis and acquired influences. J Thromb Haemost 2010; 8: 445-453.
45 Williamson D, Brown K, Luddington R. et al. Factor V Cambridge: a new mutation (Arg306 to Thr) associated with resistance to activated protein C. Blood 1998; 91: 1140-1144.
46 Mumford AD, McVey JH, Morse CV. et al. Factor V I359T: a novel mutation associated with thrombosis and resistance to activated protein C. Br J Haematol 2003; 123: 496-501.
47 Liang R, Lee CK, Wat MS. et al. Clinical significance of Arg306 mutation of factor V gene. Blood 1998; 92: 2599-2600.
48 Angchaisuksiri P, Inkaew B, Busabaratana M. et al. The factor V R2 allele (A4070G), factor V gene G1628A mutation, factor V Hong Kong (A1090G), factor V Cambridge (G1091C), the tissue factor pathway inhibitor gene C536T mutation and the risk of venous thrombosis in Thai patients. J Thromb Haemost. (Suppl) 2003 Abstract P0366.
49 Bernardi F, Faioni EM, Castoldi E. et al. A factor V genetic component differing from factor V R506Q contributes to the activated protein C resistance phenotype. Blood 1997; 90: 1552-1557.
50 Okada H, Toyoda Y, Takagi A. et al. Activated protein C resistance in the Japanese population due to homozygosity for the factor V R2 haplotype. Int J Hematol 2010; 91: 549-550.
51 Castaman G, Faioni EM, Tosetto A. et al. The factor V HR2 haplotype and the risk of venous thrombosis: a meta-analysis. Haematologica 2003; 88: 1182-1189.
52 Cai H, Hua B, Fan L. et al. A novel mutation (G2172 to C) in the factor V gene in a Chinese family with hereditary activated protein C resistance. Thromb Res 2010; 125: 545-548.
53 Kodaira H, Ishida F, Shimodaira S. et al. Resistance to activated protein C and Arg 506 Gln factor V mutation are uncommon in eastern Asian populations. Acta Haematol 1997; 98: 22-25.
54 Zama T, Murata M, Ono F. et al. Low prevalence of activated protein C resistance and coagulation factor V Arg506 to Gln mutation among Japanese patients with various forms of thrombosis, and normal individuals. Int J Hematol 1996; 65: 71-78.
55 Yanqing H, Fangping C, Qinzhi X. et al. No association between thrombosis and factor V gene polymorphisms in Chinese Han population. Thromb Haemost 2003; 89: 446-451.
56 Mutirangura P, Rüengsethakit C, Wongwanit C. Epidemiologic analysis of proximal deep vein thrombosis in Thai patients: Malignancy, the predominant etiologic factor. Int J Angio 2004; 13: 81-83.
57 Peng YY, Jeng JS, Shen MC. et al. Aetiologies and prognosis of Chinese patients with deep vein thrombosis of the lower extremities. QJM 1998; 91: 681-686.
58 Lee HC, Liao WB, Bullard MJ. et al. Deep vein thrombosis in Taiwan. Jpn Heart J 1996; 37: 891-896.
59 Lee C-H, Lin L-J, Cheng C-L. et al. Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population. J Thromb Haemost 2010; 8: 1515-1523.
60 Bhoopat L, Rojnuckarin P, Hiransuthikul N. et al. Low vegetable intake is strongly associated with venous thromboembolism in Thai population. Blood Coagul Fibrinolysis 2010; 21: 758-763.
61 Broekmans WM, Klöpping-Ketelaars IA, Schuurman CR. et al. Fruits and vegetables increase plasma carotenoids and vitamins and decrease homocysteine in humans. J Nutr 2000; 130: 1578-1583.
62 McCully K. Homocysteine, folate, vitamin B6, and cardiovascular disease. J Am Med Assoc 1998; 279: 392-393.
63 Cattaneo M, Lombardi R, Lecchi A. et al. Low plasma levels of vitamin B6 are independently associated with a heightened risk of deep-vein thrombosis. Circulation 2001; 104: 2442-2446.
64 Shahar E, Folsom AR, Wu KK. et al. Associations of fish intake and dietary n-3 polyunsaturated fatty acids with a hypocoagulable profile. The Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb 1993; 13: 1205-1212.
65 Visudhiphan S, Poolsuppasit S, Piboonnukarinir O. et al. The relationship between high fibrinolytic activity and daily capsicum ingestion in Thais. Am J Clin Nutr 1982; 35: 1452-1455.
66 Wang JP, Hsu MF, Hsu TP. et al. Antihemostatic and antithrombotic effects of capsaicin in comparison with aspirin and indomethacin. Thromb Res 1985; 37: 669-679.
67 Steffen LM, Folsom AR, Cushman M. et al. Greater fish, fruit and vegetable intakes are related to lower incidence of venous thromboembolism: The longitudinal investigation of thromboembolism etiology. Circulation 2007; 115: 188-195.
68 Jacobs DR, Steffen LM. Nutrients, foods, and dietary patterns as exposures in research: issues and challenges. Am J Clin Nutr 2003; 78 (Suppl) 508S-513S.
69 Bang SM, Jang MJ, Oh D. et al. Korean guidelines for the prevention of venous thromboembolism. J Korean Med Sci 2010; 25: 1553-1559.