CONTRIBUTION OF EXTENSIVE BIOLOGICAL WORK -UP IN PATIENTS WITH VENOUSOR ARTERIAL THROMBOTIC EVENTS

Objectives: The aim of this work is to study the signification of an e xtensive biological evaluation in patients with ''unexplained'' thromb osis. We studied 78 patients with more than one arterial and/or venous thromboembolic event. Methods: Fifty-four patients were admitted for unexplained deep venous thrombosis (group I, n=19, 9 men and 10 women) and/or arterial thrombosis (group II, n=35, 21 men and 14 women). A t hird group (group III included 24 patients (13 men, 11 women) known to have a pathologic state which can lead to a thrombotic event. Results : The patients in both groups I and II had, more often than normal sub jects, a high level of homocysteinemia (26% vs 3%, p<0.001), anti-beta 2 glycoprotein 1 (18.5% vs 3%, p<0.001) and antiphospholipid antibodi es (13% vs 3%, p<0.02). We also found a significant association betwee n an increase of erythrocytic aggregation and arterial thrombosis (gro up II). In the third group, for both arterial (n=14) and venous (n=10) thrombosis, we found a high level of anticardiolipin antibodies (25% vs 3%, p<0.001), anti-beta 2 glycoprotein 1 antibodies (12.5% vs 3%, p <0.05) and abnormal erythrocytic aggregation (16.5% vs 3%, p<0.01). In these 3 groups the other studied parameters (Lp(a), platelet aggregat ion, cryoglobulin, cryofibrinogen, antinuclear antibodies, anticytopla sm antibodies, plasma and urine immunoelectrophoresis, protein C, prot ein S, antithrombin III, plasminogen) were not different from levels o bserved in normal subjects. Conclusion: An extensive biological analys is, including plasma homocystein level, anticardiolipin antibodies, an ti-beta 2 glycoprotein 1 antibodies and a study of the erythrocytic ag gregation would appear to be of value in patients presenting recurrent arterial or venous thromboembolic events. Specific: therapy can be ap plied in case of abnormal results continued anticoagulant therapy for anticardiolipin and anti-beta 2 glycoprotein 1 antibodies, and a vitam in therapy for increased homocysteinemia.