LETTER
Risk Factors for Deep Venous Thrombosis of the Upper Extremities
Deepti Pandita, MD;
Preston Steen, MD; and
Anil Potti, MD
15 December 1997 | Volume 127 Issue 12 | Page 1129
TO THE EDITOR:
We read with interest the article by Martinelli and colleagues [1] on evaluating risk factors for deep venous thrombosis of the upper extremities. Although the authors claim to have tested their patients for all possible causes of thrombophilia, they did not mention a rare but important cause: factor XII deficiency.
We admitted a 62-year-old white woman who presented with spontaneous deep venous thrombosis in the left axillary vein. Coagulation studies done before heparin therapy was started revealed an abnormal partial thromboplastin time of 114 seconds (the normal range at our laboratory is 25 to 40 seconds). Further work-up revealed that the patient had severe factor XII deficiency. Her factor XII level was 18 U/dL on both one-stage clotting and chromogenic peptide substrate assay. This deficiency had not been identified previously because the patient had never needed a coagulation work-up.
The patient began receiving warfarin therapy, which she stopped taking after 6 months. Five months after discontinuation of therapy, she presented with bilateral femoral vein thrombosis and left femoral artery thrombosis; the latter required surgical intervention. Warfarin therapy was restarted, and the patient was advised to continue it indefinitely. Evaluation for other possible causes of thrombophilia, both inherited and acquired, was negative.
This patient's history and previous similar case reports [2, 3] illustrate the association between factor XII deficiency and increased risk for arterial and venous thrombosis. Factor XII deficiency is rare [4] but should be considered if a patient presents with an unusual site of thrombosis, such as an upper limb. If factor XII deficiency is diagnosed, lifelong anticoagulation should be considered.
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Author and Article Information
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University of North Dakota; Fargo, ND 58102
1. Martinelli I, Cattaneo M, Panzeri D, Taioli E, Mannucci M. Risk factors for deep venous thrombosis of the upper extremities. Ann Intern Med. 1997; 126:707-11.
2. Winter M, Gallimore M, Jones DW. Should factor XII assay be included in thrombophilia screening? [Letter] Lancet. 1995; 346:52.
3. Castaman G, Ruggeri M, Tosetto A, Missiaglia E, Rodeghiero F. Thrombosis in patients with heterozygous and homozygous factor XII deficiency is not explained by associated presence of factor V Leiden [Letter]. Thromb Haemost. 1996; 76:275.
4. Halbmayer WM, Haufsofer A, Schon R, Mannhalter C, Strohmer E, Baumgarten K, et al. The prevalence of moderate and severe factor XII deficiency among the normal population: evaluation of the incidence of factor XII deficiency among 300 healthy blood donors. Thromb Haemost. 1994; 71:68-72.
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