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Recurrent Deep Vein Thrombosis due to Thrombophilia

  • Rahman, Afzalur (Department of Cardiology, Sir Salimullah Medical College & Mitford Hospital) ;
  • Islam, AKM Monwarul (Department of Cardiology, National Institute of Cardiovascular Diseases) ;
  • Husnayen, SAM (Department of Cardiology, Zia Heart Foundation Hospital and Research Institute)
  • Published : 2012.05.31

Abstract

Deep vein thrombosis (DVT) is a common condition that is often under-diagnosed. Acquired or hereditary defects of coagulation or a combination of these defects may facilitate the development of DVT. Recurrent DVT, a positive family history or unusual presentation may warrant investigation for hereditary thrombophilia. Investigations are best when conducted at least one month after completion of a course of anticoagulant therapy. Most patients are managed with heparin in the acute stage overlapped by warfarin. The case presented here describes a 40-year old man undergoing three episodes of DVT. Investigations revealed protein C and protein S deficiency. Protein C, protein S and antithrombin deficiency either singly or in combination, are relatively common causes of hereditary thrombophilia. The case presented here serves as a reminder of the need to look into the underlying cause of venous thromboembolism.

Keywords

References

  1. White RH. The epidemiology of venous thromboembolism. Circulation 2003;107(23 Suppl 1):I4-8.
  2. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158:585-93. https://doi.org/10.1001/archinte.158.6.585
  3. Carter CJ. Epidemiology of venous thromboembolism. In: Hull RD, Pineo GF, editors. Disorders of Thrombosis. Philadelphia: WB Saunders;1996. p.159-74.
  4. Maheshwari A, Mehrotra A, Henry R, et al. Deep veins thrombosis. Risk and management. In: Abela GS, editor. Peripheral Vascular Disease: Basic Diagnostic and Therapeutic Approaches. Philadelphia: WB Saunders; 2004. p.452-60.
  5. Nicolaides AN, Breddin HK, Carpentier P, et al. Thrombophilia and venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence. Int Angiol 2005;24:1-26.
  6. Makris M, Preston FE, Beauchamp NJ, et al. Co-inheritance of the 20210A allele of the prothrombin gene increases the risk of thrombosis in subjects with familial thrombophilia. Thrmb Haemost 1997;78: 1426-9.
  7. Price DT, Ridker PM. Factor V Leiden mutation and the risks for thromboembolic disease: a clinical perspective. Ann Intern Med 1997;127: 895-903.
  8. Seligsohn U, Zivelin A. Thrombophilia as a multigenic disorder. Thromb Haemost 1997;78:297-301.
  9. Murin S, Marelich GP, Arroliga AC, Matthay RA. Hereditary thrombophilia and venous thromboembolism. Am J Respir Crit Care Med 1998; 158:1369-73. https://doi.org/10.1164/ajrccm.158.5.9712022
  10. Heijboer H, Brandjes DP, Buller HR, Sturk A, ten Cate JW. Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. N Engl J Med 1990;323:1512-6. https://doi.org/10.1056/NEJM199011293232202
  11. Pabinger I, Brucker S, Kyrle PA, et al. Hereditary deficiency of antithrombin III, protein C and protein S: prevalence in patients with a history of venous thrombosis and criteria for rational patient screening. Blood Coagul Fibrinolysis 1992;3:547-53. https://doi.org/10.1097/00001721-199210000-00005
  12. Thomas RH. Hypercoagulability syndromes. Arch Intern Med 2001; 161:2433-9. https://doi.org/10.1001/archinte.161.20.2433
  13. Miletich J, Sherman L, Broze G Jr. Absence of thrombosis in subjects with heterozygous protein C deficiency. N Engl J Med 1987;317:991-6. https://doi.org/10.1056/NEJM198710153171604
  14. Walker ID. Inherited thrombophilia. In: Hoffbrand AV, Catovsky D, Tuddenham EG, editors. Postgraduate Haematology. Oxford: Blackwell; 2005. p.885-99.
  15. Hao WR, Kao PF, Leong YL, et al. Recurrent deep vein thrombosis caused by inherited coagulopathy in a Japanese male. Acta Cardiol Sin 2008;24:157-60.
  16. Rees CD, Cox M, Clegg JB. World distribution of factor V Leiden. Lancet 1995;346:1133-4. https://doi.org/10.1016/S0140-6736(95)91803-5
  17. D'Angelo A, Selhub J. Homocysteine and thrombotic disease. Blood 1997;90:1-11.
  18. Bauer KA. The thrombophilias: well-defined risk factors with uncertain therapeutic implications. Ann Intern Med 2001;135:367-73.
  19. Schulman S. Management of venous thromboembolism. In: Hoffbrand AV, Catovsky D, Tuddenham EG, editors. Postgraduate Haematology. Oxford: Blackwell;2005. p.912-24.