Non-OO blood type influences the risk of recurrent venous thromboembolism

Summary

The role of ABO blood type as a risk factor for recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who complete oral anticoagulation therapy is unknown. The aim of this study was to determine if non-OO blood type is a risk factor for recurrent VTE in patients with a first unprovoked VTE who completed 5–7 months of anticoagulant therapy. In an ongoing cohort study of patients with unprovoked VTE who discontinued oral anticoagulation after 5–7 months of therapy, six single nucleotide polymorphisms sites were tested to determine ABO blood type using banked DNA. The main outcome was objectively proven recurrent VTE. Mean follow-up for the cohort was 4.19 years (SD 2.16). During 1,553 patient-years of follow-up, 101 events occurred in 380 non-OO patients (6.5 events per 100 patient years; 95% CI 5.3–7.7) compared to 14 events during 560 patient years of follow-up in 129 OO patients (2.5 per 100 patient years; 95% CI 1.2–3.7), the adjusted hazard ratio was 1.98 (1.2–3.8). In conclusion, non-OO blood type is associated with a statistically significant and clinically relevant increased risk of recurrent VTE following discontinuation of anticoagulant therapy for a first episode of unprovoked VTE.

Keywords

Veins - thrombosis - blood cells

• References

• 1 Boutitie F, Pinede L, Schulman S. et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants’ data from seven trials. Br Med J 2011; 342: d3036.
• 2 Rodger M, Carrier M, Gandara E. et al. Unprovoked Venous Thromboembolism: Short term or Indefinite Anticoagulation? Balancing Long-Term Risk and Benefit. Blood Reviews 2010; 24: 171-178.
• 3 Wu O, Bayoumi N, Vickers MA. et al. ABO(H) blood groups and vascular disease: a systematic review and meta-analysis. J Thromb Haemost 2008; 6: 62-69.
• 4 Dentali F, Sironi A, Ageno W. et al. Non-O Blood Type Is the Commonest Genetic Risk Factor for VTE: Results from a Meta-Analysis of the Literature. Semin Thromb Hemost 2012; 38: 535-548.
• 5 Jick H, Slone D, Westerholm B. et al. Venous thromboembolic disease and ABO blood type. A cooperative study. Lancet 1969; 7594: 539-542.
• 6 Ohira T, Cushman M, Tsai MY. et al. ABO blood group, other risk factors and incidence of venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology (LITE). J Thromb Haemost 2007; 5: 1455-1461.
• 7 Rodger MA, Kahn SR, Wells PS. et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ 2008; 179: 417-426.
• 8 Doi Y, Yamamoto Y, Inagaki S. et al. A new method for ABO genotyping using a multiplex single-base primer extension reaction and its application to forensic casework samples. Leg Med (Tokyo) 2004; 6: 213-223.
• 9 Kearon C, IORIO A, Palareti G. et al. Risk of recurrent venous thromboembolism after stopping treatment in cohort studies: recommendation for acceptable rates and standardized reporting. J Thromb Haemost 2010; 8: 2313-2315.
• 10 Morelli VM, De Visser MC, Vos HL. et al. ABO blood group genotypes and the risk of venous thrombosis: effect of factor V Leiden. J Thromb Haemost 2005; 3: 183-185.
• 11 Eichinger S, Heinze G, Jandeck LM. et al. Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary Embolism: The Vienna Prediction Model. Circulation 2010; 121: 1630-1636.
• 12 Linkins LA, Choi PT, Douketis JD. Clinical Impact of Bleeding in Patients Taking Oral Anticoagulant Therapy for Venous ThromboembolismA Meta-Analysis. Ann Intern Med 2003; 139: 893-900.
• 13 Baglin T, Bauer K, Douketis J. et al. Duration of anticoagulant therapy after a first episode of an unprovoked pulmonary embolus or deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost 2012; 10: 698-702.
• 14 Vormittag R, Bencur P, Ay C. et al. Low-density lipoprotein receptor-related protein 1 polymorphism 663 C-á>-áT affects clotting factor VIII activity and increases the risk of venous thromboembolism. J Thromb Haemost 2007; 5: 497-502.
• 15 Tirado I, Mateo J, Soria JM. et al. The ABO blood group genotype and factor VIII levels as independent risk factors for venous thromboembolism. Thromb Haemost 2005; 93: 468-474.
• 16 Paiva SG, Sabino AP, Carvalho MG. et al. Polymorphisms in exons 6 and 7 of the ABO locus and their association with venous thrombosis in young Brazilian patients. Blood Coagul Fibrinolysis 2009; 20: 122-128.
• 17 Schleef M, Strobel E, Dick A. et al. Relationship between ABO and Secretor genotype with plasma levels of factor VIII and von Willebrand factor in thrombosis patients and control individuals. Br J Haematol 2005; 128: 100-107.
• 18 Melzer D, Perry JRB, Hernandez D. et al. A Genome-Wide Association Study Identifies Protein Quantitative Trait Loci (pQTLs). PLoS Genet 2008; 4: e1000072.
• 19 Kyrle PA, Hron G, Eichinger S. et al. Circulating P-selectin and the risk of recurrent venous thromboembolism. Thromb Haemost 2007; 97: 880-883.
• 20 O’Donnell J, Boulton FE, Manning RA. et al. Genotype at the secretor blood group locus is a determinant of plasma von Willebrand factor level. Br J Haematol 2002; 116: 350-356.
• 21 Garcia AA, van der Heijden JF, Meijers JC. et al. The relationship between ABO blood group and the risk of bleeding during vitamin K antagonist treatment. J Thromb Haemost 2006; 4: 1418-1420.
• 22 Lind M, Boman K, Johansson L. et al. Von Willebrand factor predicts major bleeding and mortality during oral anticoagulant treatment. J Intern Med 2012; 271: 239-246.
• 23 Franchini M, Crestani S, Frattini F. et al. Relationship between ABO blood group and bleeding complications in orally anticoagulated patients. J Thromb Haemost 2012; 10: 1688-1691.