Key result
Mild hyperhomocysteinemia is a risk factor for venous thrombosis, although the 677C-->T MTHFR mutation does not appear to increase risk and the benefits of vitamin supplementation remain uncertain.
Why the study?
Is mild hyperhomocysteinemia a risk factor for venous thrombosis, and does vitamin supplementation provide clinical benefit?
Is mild hyperhomocysteinemia a risk factor for venous thrombosis, and does vitamin supplementation provide clinical benefit?
Mild hyperhomocysteinemia is a risk factor for venous thrombosis, but the clinical benefit of vitamin supplementation to lower homocysteine levels remains uncertain.
Does not support routine vitamin supplementation; leaves open targeted risk stratification pending randomized trials.
Classical homocystinuria is associated with arterial vascular diseases and venous thrombosis. In the last decade, several studies have been published indicating that even mild hyperhomocysteinemia is a risk factor for venous thrombosis. The 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene is an important cause of mild hyperhomocysteinemia, but this polymorphism does not seem to be a risk factor for venous thrombosis. Studies on the interaction between hyperhomocysteinemia and other thrombotic risk factors are conflicting. Little is known about the pathophysiology of venous thrombosis in hyperhomocysteinemia. Several mechanisms proposed for vascular disease may be applied to venous thrombosis as well. However, up to now there is no satisfying model which might explain a thrombophilic state at plasma homocysteine concentrations in the range of mild hyperhomocysteinemia. The results of a first clinical intervention study are expected in 2002. As the results are pending, clinicians could perform homocysteine measurements in patients with venous thrombosis if screening for thrombophilia is indicated. Vitamin supplementation could be prescribed if homocysteine levels are elevated. However, the patient should be informed about the uncertainty of the benefits of vitamin supplementation.
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Heijer et al. (2001) conducted a review in Venous thrombosis. Hyperhomocysteinemia was evaluated. Mild hyperhomocysteinemia is a risk factor for venous thrombosis, although the 677C-->T MTHFR mutation does not appear to increase risk and the benefits of vitamin supplementation remain uncertain.
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