We 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.3
, 5
; had the study been included there would have been no changes in the association of lower extremity peripheral arterial disease (PAD) prothrombin G20210A (pooled random effect odds ratio 1.68 [95% confidence interval 0.94–3.00]; I2 52.1%; p = .08). Furthermore, the addition of the study by Bérard et al. does not modify the association between prothrombin G20210A and critical limb ischemia secondary to PAD (even in the absence of positive cases).3
Finally, we agree that well-designed prospective cohort studies are needed to evaluate the role of prothrombin G20210A in the progression and outcome of patients with PAD.References
- Re: Prothrombin G20210A mutation and lower extremity peripheral arterial disease. A systematic review and meta-analysis.Eur J Vasc Endovasc Surg. 2015;
- Interaction of coagulation defects and cardiovascular risk factors: increased risk of myocardial infarction associated with factor V Leiden or prothrombin 20210A.Circulation. 1998; 97: 1037-1041
- Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study.PLoS One. 2013; 8: e37882
- The role of prothrombotic mutations in patients with Buerger's disease.Thromb Res. 2000; 100: 143-147
- Prothrombin G20210A mutation and lower extremity peripheral arterial disease: a systematic review and meta-analysis.Eur J Vasc Endovasc Surg. 2015; 50: 232-240
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Published online: September 22, 2015
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- Re: ‘Prothrombin G20210 Mutation and Lower Extremity Peripheral Arterial Disease: A Systematic Review and Meta-analysis’European Journal of Vascular and Endovascular SurgeryVol. 50Issue 6
- PreviewVasquez 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.
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