Talk:Thrombophilia

History
http://bloodjournal.hematologylibrary.org/cgi/content/full/112/1/19 JFW | T@lk  21:00, 10 July 2008 (UTC)

No point
Uncomplicated VTE is no indication for thrombophilia testing. In the MEGA study, those who were tested were no less likely to have a recurrence:. JFW | T@lk  19:56, 26 August 2008 (UTC)


 * PMID is wrong, but it was a primary study anyway. JFW &#124; T@lk  00:20, 21 February 2011 (UTC)

Causes
I took a clue from, who on the assessment page suggested that the list of causes probably had too many bullet points. I have started to prosaify the content, basing myself on the current references and adding a load more.

This has prompted the realisation that we are probably not discussing the specific acquired scenarios in sufficient detail. For instance, antiphospholid syndrome is (according to the Lancet review) regarded as a strong indication for long-term anticoagulation. I also need to append the relevant epidemiological data to the "epidemiology" section. JFW &#124; T@lk  10:10, 25 February 2011 (UTC)

More genetics!
10.1111/j.1538-7836.2009.03394.x is a review from two Dutch kings of genetic thrombophilia (Rosendaal and Reitsma). It is fairly short but discusses the utility of genome-wide association studies and the fact that most genetic thrombophilias confer at most a moderate risk of VTE. JFW &#124; T@lk  12:52, 27 February 2011 (UTC)

Smoking
Kumar4 is used as a source to support the claim that cigarette smoking is linked with venous thromboembolism. It turns out that it very difficult to find a good corrobative secondary source for this claim. 10.1002/ajh.21059 is a primary research study, which in turn cites (Nurses' Health Study, 1997). The topic has not been reviewed independently from OCP use. I am removing it until we can support this with better sources, and I remain open to suggestions. JFW &#124; T@lk  14:18, 27 February 2011 (UTC)

Obesity
This is little question that obesity, apart from by mechanical reasons, also has its associated thrombophilia; this is presumed to be due to PAI-1 hypersecretion by fat cells. is a review on the topic, but I can't access it currently. It should probably be included. JFW &#124; T@lk  14:25, 27 February 2011 (UTC)

Image
Unrelated to GA review: Do you think that File:Warfarintablets5-3-1.jpg (shown) might be a better choice for the likely audience than a chemical diagram? I believe it's famous for its color coding (which seems to vary by country). WhatamIdoing (talk) 18:54, 19 March 2011 (UTC)


 * I have no objection. JFW &#124; T@lk  00:11, 20 March 2011 (UTC)

Article title
I was just wondering whether the title of this article has been discussed. I don't see such a discussion here on Talk; if it occurred elsewhere please point me. The term "thrombophilia" is unlikely to mean much to non-medical readers (except perhaps students of Latin). Harrison's textbook of medicine has a section, "Hypercoagulable state" under "Thrombotic disorders", which has no mention of "thrombophilia". Likewise, Robbins textbook (cited 7 times in this article) has zero occurrences of the term "thrombophilia". What is the basis for this title? Please don't assume I am resisting this usage: I actually like the term - its etymology makes great sense - but I would guess that there's a more encyclopedic rationale than that. In particular, the pattern I'm seeing in a lot of contexts suggests that "thrombophilia" is meant to apply to congenital (rather than acquired) hypercoagulability, in a manner that somewhat parallels "hemophilia". -- Scray (talk) 18:46, 27 March 2011 (UTC)


 * I've never really reflected on the nomenclature. I have the feeling that "thrombophilia" is more prevalent in the European literature, and indeed here in the UK clinicians order the "thrombophilia screens" on patients with thrombosis. Most sources I used for this article, though - on both sides of the Atlantic - use the term thrombophilia. Perhaps the concept "prothrombotic state" is somewhat broader than thrombophilia, but I have no evidence for this assertion. For instance, diabetic ketoacidosis should rightly be considered a prothrombotic state, but I would intuitively struggle to refer to this as a thrombophilia.
 * I've just run a couple of Googlefights, and "thrombophilia" wins hands down from "prothrombotic state" and "hypercoagulable state" (make sure you include the quotation marks). JFW &#124; T@lk  20:21, 27 March 2011 (UTC)
 * FWIW, I also searched Pubmed for "thrombophilia"[ti] (1319 references), "hypercoagulable"[ti] (388 references), and "prothrombotic"[ti] (535 references). None of these metrics is authoritative, but I agree with the existing title ("Thrombophilia") even though use of the term is unfamiliar to me.  Maybe the cornfield in which I work is too isolated.  -- Scray (talk) 21:32, 27 March 2011 (UTC)
 * Surely, many texts use thrombophilia to refer specifically to the congenital or hereditary forms, but many generalize it to any prothrombotic/hypercoagulable state, and it's most appropriate to expand the scope of this article to the broadest sense, and it does so very well with the clear distinction between congenital and acquired causes. I agree hypercoagulability is more self-explanatory, but with the more common usage of thrombophilia, it seems to be appropriate enough. In short, I think the article title of Thrombophilia may remain, so no change needed. Mikael Häggström (talk) 09:57, 2 April 2011 (UTC)

Malignancy
Isn't malignancy one of the major causes of hypercoagulable states (and yes, I too see this term used much more than thrombophilia, but I digress...)? If so, I don't see much discussion of it. Am I missing something? Yobol (talk) 04:20, 30 March 2011 (UTC)


 * Some sources don't classify malignancy as a "thrombophilia" sensu strictu, possibly because cancer leads to thrombosis by other mechanisms rather than just rheological ones. For instance, large-volume retroperitoneal deposits cause flow abnormalities in the inferior vena cava and increase thrombosis risk by that mechanism. I see no problem mentioning malignancy, but it would need to have a suitable source. Heit mentions "active cancer" in his list, and so does Rosendaal2005. I will therefore add a few lines. JFW &#124; T@lk  04:25, 30 March 2011 (UTC)

Promoter region?
In regards to prothrombin G20210A I was skeptical that the promoter region was the right way to describe it, so I made this edit because that is what was verified, but I was reverted. So I looked up this and this. It's clear the 20210 refers to the position on the sense strand, where position 1 to 3 is ATG for the start codon. 20210 occurs in the 14th and last exon, but in the 3' untranslated region after the 14th exon is done coding. 20210 is also next to/near where the poly-A tail is attached on the pre-mRNA. This can't be part of the promoter region, as far as my knowledge is concerned. It was mentioned in the discussion of the 1996 publication that the polymorphism could contribute to RNA stability/translation efficiency. Biosthmors (talk) 19:58, 1 February 2012 (UTC)


 * I reverted the change only because 3' untranslated region redirects to Three prime untranslated region, and I hadn't given your distinction between 3'UTR and promotor a second thought. My apologies for missing that. I will make the required correction. JFW &#124; T@lk  20:45, 1 February 2012 (UTC)


 * Ah. No problem. My apologies for not using a more detailed edit summary. And I put the research to good use over at the other article. Thanks. Biosthmors (talk) 16:35, 3 February 2012 (UTC)

Resources
Although this article contains reasonable number of references, the reference below can be cited and resources can still be drawn from:  D ip ta ns hu Talk 08:24, 27 May 2013 (UTC)


 * I don't see how either of these sources would add anything to the current content. The first simply discusses everything we already cover and is from a low-impact journal in Eastern Europe. The second is 27 years old and would qualify as "historical interest" only. JFW &#124; T@lk  17:33, 27 May 2013 (UTC)

Risk scoring
Currently, decisions about prolonged prophylaxis and risk of recurrence in people with confirmed thrombophilia are very non-evidence based, and I wonder if there is a risk of defensive practice. Two French groups have proposed a risk score (MARNI) - 10.1111/jth.12461 that needs validation and is therefore not ready for inclusion, but something that is likely to become a feature of risk assessment in the future. JFW &#124; T@lk  16:35, 12 December 2013 (UTC)
 * There are about 4-5 scoring systems to quantify the risk for thrombosis. They will appear shortly in the article on Thrombosis prevention
 * Barbara (WVS) (talk) 14:21, 24 December 2016 (UTC)

Circulation
Review by Heit 10.1161/CIRCULATIONAHA.113.001943 JFW &#124; T@lk  21:15, 14 January 2014 (UTC)


 * 10.1161/CIRCULATIONAHA.113.007664 - further review by Piazza. JFW &#124; T@lk  19:09, 20 July 2014 (UTC)

NEJM
10.1056/NEJMra1700365 JFW &#124; T@lk  11:41, 24 September 2017 (UTC)

Celiac Disease
CD seems to be a significant risk factor, see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616811/ --2A02:560:4147:A600:D14C:5C05:3258:AA20 (talk) 10:58, 23 March 2019 (UTC)