AMBULATORY VENOUS THROMBOEMBOLISM CRITICA L MANIFESTATIONS AND ETIOLOGIES

Objectives: Venous stasis in bedridden patients is recognized as one o f the risk factors for venous thromboembolism but the phenomena is kno wn to occur in ambulatory subjects and another cause must be involved. We investigated a series of consecutive ambulatory patients with veno us thromboembolism in order to distinguish the particular clinical man ifestations and possible aetiologies. Methods: We compared a retrospec tive series of 120 consecutive patients with deep vein thromboembolism of the lower limbs and 127 patients with the same disease who had bee n bedridden at onset. In addition to the physical examination, the aet iological work-up included echography (n=14), abdominal computed tomog raphy (n=38) and/or haemostasis studies (n=61). Mean follow up was 23/-13 months (range 1-45 months). Results: Family history of deep venou s thromboembolism was found in 17 patients and recurrence was observed in 50 patients. Phlebitis was on the right in 52 cases, on the left i n 47 and bilateral in 17. Proximal locations were more frequent (74%) and pulnonary embolism occurred in one-half of the patients (n=58). A cause was identified in 61 cases (50.8%): cancer (n=24, 17 known, 7 pr eviously unknown), dyscrasia (n=17, protein 8 or C deficiency (5), inc reased plasminogen activator inhibitor I (8), circulating anticoagulan ts (3), hypofibrinogen (1), idiopathic varicose veins (n=7), pregnancy (n=5), oral contraceptives (n=4) and other causes (n=4). No cause was identified in 59 patients. Pulmonary embolism led to death in 4 cases . Seven patients were lost to follow-up and anticoagulation therapy wa s taken by 79 (72%) then interrupted in the others 3 to 6 months later . Eighteen patients died, 14 due to the underlying disease, 2 from new cancers and 12 after recurrent thromboembolism. Conclusion: Ambulator y venous embolism is as frequent as embolism in bedridden patients and the cause can be observed in 50% of tbe cases.