Question From the Clinician: Risk of Thrombophilia
Notice bibliographique
Résumé
A 17-year-old girl meets with you to discuss her use of oral contraceptives (OCPs) that contain estrogen. In the family history focusing on evidence of thrombophilia, you find that the patient’s father died of a pulmonary embolus after disembarking from a transatlantic airplane flight. The patient and her mother want to know if she should use OCPs. The girl is leaving for college, and there is concern for an unwanted pregnancy on the one hand and the risk of thrombosis on the other. How should you advise her?In this case, the family history provides a vital piece of information in assessing risk of thrombosis for this patient using OCPs. The current guidelines of the American College of Obstetrics and Gynecology do not recommend laboratory testing for thrombophilia if a careful family history is unrevealing. (1) In view of the father’s pulmonary embolus and demise, a consideration of inherited abnormalities that may predispose to a thrombus and acquired conditions that may provoke a thrombus is warranted. The father’s long airplane ride, particularly if it was in the coach section with limited mobility, is a risk factor for a lower extremity or pelvic thrombus and consequent pulmonary embolus, although at least one-third to one-half of the adult patients who experience pulmonary emboli do not have an identifiable source of the embolization. (2) The thrombotic risk would be heightened if he had an underlying malignancy or inflammatory disease, but there was no history of either of these conditions.If the immobilization of the airplane ride were coupled with an inherited thrombophilic condition, such as factor V Leiden (5% of the population), the risk would be more than additive. In the scenario presented, we have no information about an underlying thrombophilic mutation; but the population frequency of such abnormalities makes it reasonable to explore this possibility in this young woman in view of her positive family history, because such a mutation would increase her risk of a thrombus if she used OCPs.An established thrombophilia panel includes genetic and plasma-based testing, (3)(4)(5) as follows:The results of plasma-derived coagulation tests performed in children should be compared with their respective age-appropriate values. (6) Furthermore, each thrombophilic factor noted presents a different risk for the development of a thrombus. (7)The routine testing of children for both acquired and inherited conditions is controversial, given the low prevalence of thrombotic events, the even lower prevalence of unprovoked events, and the variable presence of external risk factors (eg, limited mobility, central lines, estrogen-containing OCP medications). Thrombophilia testing to determine the duration of anticoagulation in children or to prevent venous thromboembolism or life-threatening events in adolescent patients being considered for oral contraception has not been recommended in the absence of a family or patient history of thrombosis. (8)(9)The patient in the case described should have a complete evaluation for a thrombophilic factor. If a risk factor is identified, estrogen-containing OCPs should not be used. If an abnormality is detected, it would be beneficial to take a multidisciplinary approach, involving a pediatric hematologist and a gynecologist, to consider the different contraceptive methods that are compatible with the results of the thrombophilia investigation. (10) Current data do not indicate any heightened risk of thrombosis with the use of progesterone alone as a contraceptive, and numerous barrier methods of contraception are available. Importantly, additional modifiable risk factors such as obesity, inappropriate diet and sedentarism, and exposure to alcohol and tobacco also need to be addressed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».