Correspondence
Postpartum Venous Thromboembolism
N Engl J Med 2009; 360:1574April 9, 2009
- Article
To the Editor:
In their Image in Clinical Medicine, Zalts and Hayek (Dec. 18 issue)1 describe a woman with postpartum venous thromboembolism. The patient was found to be heterozygous for a mutation in the gene encoding for 5,10-methylenetetrahydrofolate reductase (MTHFR). The authors suggest that the mutation was most likely the source of her susceptibility to hypercoagulation. However, a recent, large-scale, prospective study involving 66,140 participants did not show an association between a homozygous or heterozygous MTHFR genotype and the risk of venous thromboembolism.2 The odds ratio for the development of venous thromboembolism was 1.01 for the heterozygous (C677CT) or homozygous (C677TT) genotype, as compared with the normal MTHFR genotype. Moreover, a heterozygous genotype was found in 41% of the population, in both the case and control groups, suggesting a much higher prevalence of the aberrant genotype than of venous thromboembolism.2 Therefore, in the patient described by Zalts and Hayek, the acquired risk factors (pregnancy and postpartum period, surgery, and reduced mobility), which were recently reviewed in the Journal, 3 appear to be a more likely cause of venous thromboembolism than the observed mutation in the gene encoding MTHFR.
3 ReferencesPaul Stoll, M.D.
J. Christian Virchow, M.D.
Marek Lommatzsch, M.D.
University Medical Clinic Rostock, 18057 Rostock, Germany
paul.stoll@med. uni-rostock. de 1
Zalts R ,Hayek T . Postpartum venous thromboembolism. N Engl J Med 2008;359:2706-2706
Full Text | Web of Science | Medline2
Naess IA ,Christiansen SC ,Romundstad PR , et al. Prospective study of homocysteine and MTHFR 677TT genotype and risk for venous thrombosis in a general population -- results from the HUNT 2 study. Br J Haematol 2008;141:529-535
CrossRef | Web of Science | Medline3
Tapson VF . Acute pulmonary embolism. N Engl J Med 2008;358:1037-1052
Full Text | Web of Science | Medline
