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kola tromb zy, ilina, 19.-21.9.2008

. . tromb?za. n?dor. antifosfolipidov? protil?tky. vroden? trombof?lia . HIT. ak?tna infekcia. hyperlipid?mia. hypertenzia. vek. fajcenie. tehotenstvo. . . . . . . . . . . in?. . n?dory, vroden? trombof?lia a tromb?za. . upraven? podla Bick RL., J Supportive Oncology 2006; 4 (3): 115-120. mechanizmu

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kola tromb zy, ilina, 19.-21.9.2008

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    1. kola trombzy, ilina, 19.-21.9.2008 ndory a vroden tromboflia J.Stako, NCHT a KHaT JLF UK, Martin

    3. mechanizmus aktivcie hemostzy ndorom

    5. kritri vrodenej tromboflie - 1

    7. vroden tromboflia (trombofiln stavy silno podporen dkazmi) - deficit antitrombnu (AT) - deficit protenu C (PC) - deficit protenu S (PS) - rezistencia na aktivovan proten C (APC-R), vrtane FV Leiden - mutcia protrombnu G20210A - homocystinria

    8. vroden tromboflia (trombofiln stavy podporen dkazmi) - syndrm lepivch doticiek (sticky platelet syndrome) * - zven plazmatick hladiny faktorov I,II,VIII,IX,XI - polymorfizmus FXIII - hyperhomocysteinmia (HHcy) - dysfibrinogenmia - znen inhibtor systmu tkanivovho faktora (TFPI) - polymorfizmus trombomodulnu (TM)

    9. vroden tromboflia (trombofiln stavy slabo podporen dkazmi) - znen proten Z - znen tkanivov aktivtor plazminognu (t-PA) - zven inhibtor aktivtora plazminognu (PAI-1) - zven trombnom aktivovateln inhibtor fibrinolzy (TAFI) - hypoplazminogenmia a dysplazminogenmia - hypofibrinolza

    11. koagulacn kaskda

    12. regulcia koagulcie protenom C (PC)

    13. vroden rezistencia na APC faktor V Leiden

    15. faktor V Leiden vznamn prevalencia: vskyt len u bielej rasy 3 6 % celkovo v populcii 20 40 % u pacientov s trombzou ? rizika trombzy: u homozygotov 50 100 x u heterozygotov 5 10 x

    16. faktor V Leiden relatvne riziko pre prv epizdu VTE

    17. vybrat zskan rizikov faktory VTE

    18. prospektvna tdia porovnvajca prevalenciu FV Leiden u 55 pacientov s ndorom a VTE, 58 pacientov s ndorom a bez VTE, 54 pacientov s VTE a bez ndoru a 56 zdravch jedincov: vroden tromboflia a ndory

    19. prospektvna tdia porovnvajca prevalenciu FV Leiden u 55 pacientov s ndorom a VTE, 58 pacientov s ndorom a bez VTE, 54 pacientov s VTE a bez ndoru a 56 zdravch jedincov: vroden tromboflia a ndory

    20. vroden tromboflia a ndory V metaanalze 10 tdi s 1000 pac. s ndorom a centrlnym venznym kattrom (CVK): RR pre FVL =13,1% RR pre mutciu protrombnu: 4,5% zver: prtomnost FVL a mutcie protrombnu zvyuje riziko trombzy CVK u pacientov s ndorom

    21. v pilotnej tdii 36 detskch pacientov s trombzou a ndorom CVK bola trombza CVK u 3 pacientov (2 heterozygoti pre MTHFR mutaciu a 1 heterozygot pre deficit proteinu C) 1 pacient s kombinciou vrodenej tromboflie (deficit PC a PS, heterozygot pre MTHFR) nemal trombzu CVK zver: vroden tromboflia nezvyuje vskyt trombzy CVK u det s ndorom vroden tromboflia a ndory

    22. zver vskyt vrodenej tromboflie u pacientov s ndorom a VTE sa vznamne neodliuje od jej vskytu v benej populcii u pacientov s ndorom je vznamnm protrombotickm rizikovm faktorom pre VTE zskan APC rezistencia u dospelch pacientov s ndorom je vroden tromboflia (mutcia FV Leiden a mutcia protrombnu) rizikovm faktorom pre trombzu CVK

    24. u koho je indikovan vyetrenie na trombofiln stav ?

    25. u koho je indikovan vyetrenie na trombofiln stav ?

    26. kto profituje z poznania trombofilnho stavu ?

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