PMID- 11115343
OWN - NLM
STAT- MEDLINE
DCOM- 20010202
LR  - 20190704
IS  - 0004-0010 (Print)
IS  - 0004-0010 (Linking)
VI  - 135
IP  - 12
DP  - 2000 Dec
TI  - Factor V leiden and morbid obesity in fatal postoperative pulmonary embolism.
PG  - 1410-3
AB  - HYPOTHESIS: Currently, the risk for postoperative acute pulmonary embolism (APE) 
      is assessed clinically. We hypothesize that the expensive screening for the most 
      common genetic thrombophilic clotting defect (factor V Leiden; R(506)Q) after 
      exclusion of established clinical risk factors does not offer additional benefit 
      to surgical patients. DESIGN: We reviewed protocols and histories from 8249 
      consecutive autopsies performed at the Mayo Clinic, Rochester, Minn. All patients 
      who died of APE after routine surgery and who lacked any other clinical risk 
      factors for APE were included and compared with matched controls. Genomic DNA was 
      extracted from archival tissues and examined for R(506)Q by polymerase chain 
      reaction amplification, restriction enzyme digestion, and direct sequencing. 
      RESULTS: Acute pulmonary embolism was the immediate cause of death in 454 
      patients (5.5%). Of those, 32 (7.0%) had undergone routine surgery. These 
      patients represent less than 0.07% of all case-adjusted surgical procedures in 
      the same period. The rate of postoperative death from APE was higher after 
      neurosurgical procedures (0.3%) than all other procedures (0.04%). Sixteen 
      patients (50.0%) were morbidly obese. Only 1 patient was heterozygous and none 
      were homozygous for R(506)Q. CONCLUSIONS: (1) Fatal APE is uncommon in surgical 
      patients lacking clinically apparent risk factors for venous thromboembolism. (2) 
      Neurosurgical patients are at increased risk for postoperative APE. (3) Morbid 
      obesity is a major independent risk factor in cases of sudden death from APE 
      postoperatively. (4) Routine preoperative screening for R(506)Q in the factor V 
      gene does not appear to offer additional benefit in surgical patients without 
      clinically recognizable thromboembolic risk factor(s).
FAU - Blaszyk, H
AU  - Blaszyk H
AD  - Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 
      55905, USA.
FAU - Bjornsson, J
AU  - Bjornsson J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arch Surg
JT  - Archives of surgery (Chicago, Ill. : 1960)
JID - 9716528
RN  - 0 (factor V Leiden)
RN  - 9001-24-5 (Factor V)
SB  - IM
CIN - Arch Surg. 2001 Feb;136(2):237. PMID: 11177148
MH  - Activated Protein C Resistance/*blood
MH  - Acute Disease
MH  - Cause of Death
MH  - Factor V/*analysis
MH  - Female
MH  - Humans
MH  - Male
MH  - Obesity, Morbid/*blood/*complications
MH  - Postoperative Complications/*epidemiology/*etiology/mortality
MH  - Pulmonary Embolism/*epidemiology/*etiology/mortality
MH  - Risk Factors
EDAT- 2000/12/15 11:00
MHDA- 2001/03/03 10:01
CRDT- 2000/12/15 11:00
PHST- 2000/12/15 11:00 [pubmed]
PHST- 2001/03/03 10:01 [medline]
PHST- 2000/12/15 11:00 [entrez]
AID - soa0078 [pii]
AID - 10.1001/archsurg.135.12.1410 [doi]
PST - ppublish
SO  - Arch Surg. 2000 Dec;135(12):1410-3. doi: 10.1001/archsurg.135.12.1410.