Vasquez et al.
1
showed that prothrombin G20210 mutation is significantly elevated in patients with peripheral occlusive arterial disease (POAD) suffering from critical limb ischemia (CLI) but not in the others. Interestingly, this mutation has been reported to be more prevalent in patients with Buerger's disease.2
, 3
Avcu et al.2
found an increased frequency of the G20210 mutation in Buerger's disease (OR 7.98, 2.45–25.13). Buerger's disease is characterized by diffuse arterial thrombosis and a severe clinical picture, most often at the CLI stage. In a recently published case control study among patients with premature POAD the author's team found that G20210 mutation was significantly more frequent in Buerger's disease (4.2% vs. 1.7 in controls).3
This difference was not found for atherosclerosis related POAD (2.6%). When compared with the 64 POAD patients, the 49 with Buerger's disease had CLI in 88% versus 28% in atherosclerosis related POAD. As suggested by Vasquez et al.,1
G20210 mutation might be one among several factors favouring thrombosis and leading to CLI in POAD, and prospective cohort studies would be useful to evaluate the role of this mutation to predict progression in POAD.References
- Prothrombin G20210 mutation and lower extremity peripheral arterial disease: a systematic review and meta-analysis.Eur J Vasc Endovasc Surg. 2015; 50: 232-240
- The role of prothrombotic mutations in patients with Buerger's disease.Thromb Res. 2000; 100: 143-147
- Novel risk factors for premature arterial occlusive disease in non diabetic patients: a case-control study.PloS One. 2013; 8: e37882
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Published online: September 15, 2015
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© 2015 European Society for Vascular Surgery. Published by Elsevier Inc.
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- Response to ‘Re: Prothrombin G20210A Mutation and Lower Extremity Peripheral Arterial Disease. A Systematic Review and Meta-analysis’European Journal of Vascular and Endovascular SurgeryVol. 50Issue 6
- PreviewWe read with interest the letter by Boulon et al.1 The proposed association between prothrombin G20210A and thromboangiitis obliterans is very interesting. Prior studies have suggested that prothrombin G20210A interacts with other cardiovascular risk factors (especially smoking) to increase the risk of vascular events,2 and this interaction could further explain the association of prothrombin G20210A and thromboangiitis obliterans seen by Bérard et al. and Avcu et al.3,4 The literature search conducted in our systematic review did not identify the study by Bérard et al.
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