Korean Circ J.  2012 May;42(5):345-348. 10.4070/kcj.2012.42.5.345.

Recurrent Deep Vein Thrombosis due to Thrombophilia

• Rahman A
• Islam AM
• Husnayen S

• KMID: 2028764
• DOI: http://doi.org/10.4070/kcj.2012.42.5.345

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.

Keyword

Deep vein thrombosis; Thrombophilia

MeSH Terms

Heparin
Humans
Protein C
Protein S
Protein S Deficiency
Thrombophilia
Venous Thromboembolism
Venous Thrombosis
Warfarin
Heparin
Protein C
Protein S
Warfarin

Figure

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  Fig. 1 Left popliteal venous thrombosis.

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  Fig. 2 Incompletely recanalized left external iliac vein.

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  Fig. 3 Incompletely recanalized left common femoral vein.

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  Fig. 4 Normal pulmonary arteries shown on the CT angiogram.

Reference

1. White RH. The epidemiology of venous thromboembolism. Circulation. 2003. 107:23 Suppl 1. I4–I8.

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. 158:585–593.

3. Carter CJ. Hull RD, Pineo GF, editors. Epidemiology of venous thromboembolism. Disorders of Thrombosis. 1996. Philadelphia: WB Saunders;159–174.

4. Maheshwari A, Mehrotra A, Henry R, et al. Abela GS, editor. Deep veins thrombosis. Risk and management. Peripheral Vascular Disease: Basic Diagnostic and Therapeutic Approaches. 2004. Philadelphia: WB Saunders;452–460.

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. Thromb Haemost. 1997. 78:1426–1429.

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. 158:1369–1373.

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. 323:1512–1516.

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. 3:547–553.

12. Thomas RH. Hypercoagulability syndromes. Arch Intern Med. 2001. 161:2433–2439.

13. Miletich J, Sherman L, Broze G Jr. Absence of thrombosis in subjects with heterozygous protein C deficiency. N Engl J Med. 1987. 317:991–996.

14. Walker ID. Hoffbrand AV, Catovsky D, Tuddenham EG, editors. Inherited thrombophilia. Postgraduate Haematology. 2005. Oxford: Blackwell;885–899.

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. 24:157–160.

16. Rees CD, Cox M, Clegg JB. World distribution of factor V Leiden. Lancet. 1995. 346:1133–1134.

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. 135:367–373.

19. Schulman S. Hoffbrand AV, Catovsky D, Tuddenham EG, editors. Management of venous thromboembolism. Postgraduate Haematology. 2005. Oxford: Blackwell;912–924.