HYPERCOAGULABLE STATES AS AN EVOLVING RISK FOR SPONTANEOUS VENOUS ANDARTERIAL THROMBOSIS

This study of 49 patients with spontaneous venous and arterial thrombo sis identified 27 with hypercoagulable states: 13 had only venous thro mbosis (VT), six had episodes of VT followed by arterial thrombosis (A T) and eight had AT only. Ah 27 patients were less than 42 years of ag e; 22 had specific natural anticoagulant or fibrinolytic deficiencies: antithrombin III (nine patients), protein C (eight patients), protein S (three patients), heparin cofactor II (two patients), tissue plasmi nogen activator release (one patient) and mixed antithrombin m and pro tein S (one patient). The remaining five patients had recurrent thromb otic events associated with resistance to heparin anticoagulation, but no established laboratory diagnosis. Clotting complications included recurrent VT, pulmonary embolism, multiple failed arterial procedures and lower extremity amputation. The remaining 22 patients (mean age of 53 years, range of 46 to 63 years), 12 with VT and ten with AT, did n ot have laboratory evidence of hypercoagulability and none had recurre nt vascular occlusions. All these patients were successfully treated b y conventional therapy without any additional thrombotic events during the follow-up period. Young adults with spontaneous thrombotic events should be screened for possible hypercoagulable states. Additionally, these young patients need further evaluation and treatment of cardiov ascular risk factors. Those with premature atherosclerosis have an esp ecially poor prognosis despite surgical intervention and anticoagulant therapy.