Thrombophilia Is Frequent in Superficial Vein Thrombosis and Is Associated with Recurrence: A Retrospective Study

Abstract number: P1649

Marcucci R, Ciuti G, Balgojevich E, Lenti M, Lucarini L, Rossi L, Evangelisti L, Gensini GF, Abbate R, Prisco D

Superficial vein thrombosis (SVT), also called superficial thrombophlebitis, is a very common disease even thought its incidence rate has never been properly assessed. Until now, the literature on this topic has been relatively poor and with a lot of methodological drawbacks, probably because this disease was considered benign and trivial. However, the recent recognition of its association with deep venous thrombosis (DVT) and the possibility of pulmonary embolism has revived the interest in this type of disease and has called for new therapeutic research. Aim of our study was to determine the thrombophilic risk profile of patients with SVT by evaluating a number of genetic and metabolic risk factors: Factor V Leiden, prothrombin polymorphism, physiological clotting inhibitors (antithrombin, protein C and S), antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies), homocysteine, plasminogen activator inhibitor-1 (PAI-1) and lipoprotein (a). The study population consisted of 183 patients (1387 F/45 M; age 42 (15–74) yrs) referred to the Thrombosis Center of Florence and 183 age and sex matched (138 F/45 M; age 42 (15–74) yrs) controls. In 103/183 (56.3%) patients the first episode of SVT occurred spontaneously, whereas in the others (43.7%) there was at least one circumstantial risk factor (34 during pregnancy; 10 after surgery; 22 on oral contraceptives/hormone replacement therapy; 14 after immobilization). At the multivariate analysis adjusted for age, sex, circumstantial and thrombophilic risk factors, independent risk factors for SVT were: factor V Leiden (OR 12.3 (95% CI 5.0–30.2), P < 0.000); hyperhomocysteinemia (OR 6.2 (95% CI 2.8–13.7), P < 0.000); antiphospholipid antibodies (OR 5.1 (95% CI 1.6–16.4), P < 0.006) and prothrombin polymorphism (OR 3.5 (95% CI 10.1–12.5), P < 0.000). Of all the patients, 106 (57.9%) had at least one recurrence of venous thromboembolism (either SVT or DVT). At the multivariate analysis adjusted for age, sex, circumstantial and thrombophilic risk factors, independent risk factors for recurrences were: hyperhomocysteinemia (OR 4.2 (95% CI 1.6–11), P < 0.003); factor V Leiden (OR 2.5 (95% CI 1.1–5.7), P < 0.002) and the occurrence of a first idiopathic episode (OR 2.0 (95% CI 1.05–4.1), P < 0.002). Thirty-four out of 183 (13.1%) had a deep vein thrombosis after the first SVT. At the multivariate analysis adjusted for age, sex, circumstantial and thrombophilic risk factors, independent risk factor for a second episode of deep vein thrombosis were: prothrombin polymorphism (OR 12.6 (95% CI 2.9–53.9), P < 0.001) and hyperhomocysteinemia (OR 4.6 (95% CI 1.7–12.6), P < 0.003). No significant differences were detected in the prevalence of thrombophilic risk factors between idiopathic and secondary SVT and between thrombophlebitis on varicose veins or not. Our findings indicate that a thrombophilic state is frequently present in patients with SVT.