Higher prevalence of thrombophilia in patients with varicose veins and venous ulcers than controls.
BACKGROUND
Uncontrolled studies suggest that patients with chronic venous ulceration (CVU) have an increased prevalence of thrombophilia, similar to that observed in patients with deep vein thrombosis. This study compared the nature and prevalence of thrombophilia in patients with varicose veins (VV, CEAP clinical [C] grade C(2) to C(3)) and patients with CVU (C(5) to C(6)) with an age- and sex-matched population without clinical or duplex ultrasound evidence of venous disease.


METHODS
Twenty-seven patients with VV, 27 patients with CVU, and 54 age- and sex-matched case controls with no clinical or duplex evidence of lower limb venous disease, underwent testing for factor V Leiden and prothrombin 20210A mutations, antithrombin deficiencies, and levels of antiphospholipid antibodies, homocysteine, protein C and S, and factor VIII, IX, and XI.


RESULTS
The overall prevalences of single and multiple thrombophilias were significantly higher in cases than in controls. Specifically, in VV patients, the prevalences of no, single, and multiple thrombophilias were 33%, 52%, and 15%, respectively, compared with 63%, 26%, and 11% in VV controls. In CVU patients, the prevalences of no, single, and multiple thrombophilias was 26%, 30%, and 44%, respectively, compared with 66%, 22%, and 11% in CVU controls. Compared with controls, only factor XI levels were significantly higher in VV patients, and homocysteine and factor VIII, IX, and XI levels were all significantly higher in CVU patients.


CONCLUSIONS
Patients with VV, and particularly CVU, have significantly higher prevalences of single and multiple thrombophilias than age- and sex-matched controls without clinical or duplex evidence of lower limb venous disease. These data support the hypothesis that thrombophilia predisposes to the development of superficial and deep lower limb venous reflux, and so VV and CVU, through the increased occurrence of clinical and subclinical thrombosis.
Darvall
Katy A L
KA
Department of Vascular Surgery, Birmingham University, Heart of England NHS Trust, Birmingham, United Kingdom. katydarvall@btinternet.com
Sam
Rachel C
RC
Adam
Donald J
DJ
Silverman
Stanley H
SH
Fegan
Christopher D
CD
Bradbury
Andrew W
AW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000991:Antithrombins / Q000172:deficiency; D015415:Biomarkers / Q000097:blood; D001779:Blood Coagulation Factors / Q000032:analysis; D016022:Case-Control Studies; D002908:Chronic Disease; D005165:Factor V / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011516:Prothrombin / Q000235:genetics; D012307:Risk Factors; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000097:blood / Q000453:epidemiology* / Q000235:genetics; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000235:genetics; D014648:Varicose Veins / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000235:genetics
D017152:Antibodies, Antiphospholipid; D000991:Antithrombins; D015415:Biomarkers; D001779:Blood Coagulation Factors; D011486:Protein C; D017293:Protein S; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin