LOW-PREVALENCE OF THROMBOPHILIC COAGULATION DEFECTS IN PATIENTS WITH DEEP-VEIN THROMBOSIS OF THE UPPER LIMBS

While many studies have demonstrated the pathogenetic role of inherite d deficiency of natural clotting inhibitors in patients in the develop ment of deep vein thrombosis of lower limbs, no data are available on the prevalence of these abnormalities in patients with upper vein thro mbosis. In this study, antithrombin III, protein C, protein S, plasmin ogen, resistance to activated protein C and factor V Leiden mutation w ere assayed in 27 consecutive patients with thrombosis of upper extrem ities. Only two patients (7.4%) showed a congenital defect (one patien t with deficiency of protein C, confirmed by family study, and one pat ient with factor V Leiden mutation). Anticardiolipin antibodies were a lso measured and four patients (14.8%) had increased levels, confirmed on a subsequent occasion 3 months later. Eighteen out of 27 patients (67%) had a predisposing or triggering factor, thus emphasizing the ro le of physical stress in the development of upper vein thrombosis. At variance with what is observed in deep vein thrombosis of the lower li mbs, inherited clotting abnormalities seem to be rarely responsible fo r upper vein thrombosis, whereas anticardiolipin antibodies and cancer are implicated in a significant proportion of cases.