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C0572: Oral Contraceptive and Deep Venous Thrombosis (DVT) in a Department of Internal Medicine
S114
POSTERS / Thrombosis Research 133S3 (2014) S35–S123
quantified by flow cytometry and CEC were measured by an immunomagnetic technique and immuno-fluorescence microscopy. Classical cardiovascular risk factors (diabetes, hypertension, dyslipemia), prevalence of arterial or venous thrombosis and circulating aPL, including lupus anticoagulant (LA), anticoardiolipin (aCL) and standard biochemical and hematological tests were also analyzed. Results: All patients and controls were of reproductive age (38 and 35, respectively). The 78.4% of patients had history of recurrent abortions and 40.5% of fetal losses. The most common positive antibodies were immunoglobulin anticardiolipin (G + M, 78%) and LA 42%. The prevalence of arterial and venous thrombosis was 21.6%, and of hypertension and hypercholesterolemia 13%. Levels of CEC, MP and TF were significantly increased in patients compared with controls. When patients were grouped by those suffering thrombosis and those without, MP levels showed a significant increase of 1.8 times higher in patients with thrombosis, and D-dimer and vWF of 1.6 and 1.5 times higher, respectively. No differences in markers of endothelial dysfunction were observed when patients were grouped by their positivity for LA, abortions and fetal losses. The levels of other laboratory tests analyzed were similar in patients and controls. Conclusions: Our study demonstrates the presence of a substantial risk of thrombotic events in women with history of obstetric antiphospholipid syndrome. In these patients, circulating CEC, MP, and TF as endothelial dysfunction biomarkers, showed relevant differences with the healthy women. Therefore, their determination may have some interest in the prediction of thrombotic risk, although these findings must be confirmed in further studies with a larger number of patients. C0572 ORAL CONTRACEPTIVE AND DEEP VENOUS THROMBOSIS (DVT) IN A DEPARTMENT OF INTERNAL MEDICINE F. Ajili1 , A. Laanani1 , W. Sassi1 , s. Sayhi1 , N. Boussetta1 , J. Laabidi1 , B. Louzir1 , N. Ben Abdelhafidh1 , S. Othmani1 . 1 Military hospital of Tunis, Tunisia Background: The incidence of venous thrombosis is low before age 40; it increases in women with combined oral contraceptives (COC). With these drugs, there is an hypercoagulable state, characterized by increased levels of fibrinogen, factor VII and factor X, and a decrease in the physiological coagulation inhibitor, antithrombin and protein S in plasma. Hyper-fibrinolysis is also observed with the increase of plasminogen and decrease rate of PAI-1 inhibitor (plasminogen activator), and acquired resistance to activated protein C. Methods: This is a retrospective study in a department of internal medicine, including records of patients hospitalized for DVT diagnosed between 2004 and 2013. The etiological investigation and research of a thrombophilia were performed in our patients. Results: Of 100 cases of DVT noted during the same period, 46 women had DVT, 6 cases (13%) of DVT occurred associated with the use of the COC were retained. There mean age was at 36 years (30–47 years). The mean BMI was 28 kg/m2 (50% of BMI > 30 kg/m2 ). Type II diabetes and a history of miscarriages were found in two patients each. A family history of DVT was noted in one patient. All patients were put on COC of second generation for an average of two years. There were no risk factors for thrombosis except the notion of varicose veins (3 cases). The topography of DVT was lower limbs with proximal location. One case was complicated by pulmonary embolism. The etiological investigation showed hyperhomocysteinemia (2 cases) and varicose veins (3 cases). All other investigations showed no abnormalities. Our patients were all put on anticoagulant therapy (mean duration 6 months), with good evolution without recurrence of thrombosis. The COC were stopped.
Conclusions: In addition to the need to focus on prescribing COC of second generation (norgestrel, levonorgestrel), it is important to remember the importance of seeking and trace risk factors for thrombosis before prescribing a COC to a “new patient”. C0601 ANTI-XA LEVELS IN PREGNANT WOMEN RECEIVING 5,000 IU DALTEPARIN DAILY M. Bozic Mijovski1 , M. Kozak1 . 1 University Medical Centre Ljubljana, Dpt. Vascular Diseases, Slovenia Background: Pregnant women at increased risk of venous thromboembolism usually receive thromboprophylaxis (lowmolecular weight heparin, LMWH) throughout pregnancy and postpartum. Regular laboratory monitoring of LMWH therapy with anti-Xa assay is not recommended, therefore, little is known about anti-Xa activity in this patient population. Methods: One hundred and twelve pregnant women receiving 5,000 IU dalteparin daily were included in the study. Blood was drawn at gestational weeks 5–10, 11–15, 16–20, 21–25, 26–30, 31–35 and 36–40 each time 4 hours after the last dalteparin dose and collected into vacuum tubes containing 0.11 M sodium citrate (Becton Dickinson, Vacutainer System Europe, Germany), centrifuged within 4 h of venepuncture at 4°C and 2000g for 30 minutes, snap frozen and stored at −70°C until analyzed. In all samples anti-Xa activity was measured with Berichrom Heparin (Siemens, Germany) on the CS2100i coagulation analyzer (Sysmex, Japan). Results: During pregnancy there was no significant fluctuation in the average anti-Xa activity (ANOVA p for anti-Xa between weeks of gestation was non-significant). However, there was wide variability in anti-Xa activity between patients (Table). About 20% of all pregnant women had anti-Xa levels already in the therapeutic range (0.50–1.00 IU/mL), and on two occasions even above 1.00 IU/mL. Table: Anti-Xa activity in pregnant women receiving 5,000 IU dalteparin daily Week of gestation
N
Arithmetic mean ± SD
Min-max
N (%) in therapeutic range a
5–10 11–15 16–20 21–25 26–30 31–35 36–40
15 52 47 60 57 64 35
0.38±0.21 0.39±0.19 0.36±0.17 0.33±0.16 0.32±0.15 0.35±0.18 0.34±0.20
0.00–0.77 0.00–0.80 0.00–0.69 0.00–0.72 0.00–0.66 0.00–1.09 0.04–1.16
3 (20) 13 (25) 10 (21) 10 (17) 6 (11) 11 (17) 5 (14)
a
Anti-Xa >0.50 IU/mL.
Conclusions: We reported a wide range of anti-Xa activity in pregnant women receiving prophylactic doses of dalteparin. The efficacy of LMWH prophylaxis according to anti-Xa activity should be established in further studies.
POSTERS / Thrombosis Research 133S3 (2014) S35–S123
quantified by flow cytometry and CEC were measured by an immunomagnetic technique and immuno-fluorescence microscopy. Classical cardiovascular risk factors (diabetes, hypertension, dyslipemia), prevalence of arterial or venous thrombosis and circulating aPL, including lupus anticoagulant (LA), anticoardiolipin (aCL) and standard biochemical and hematological tests were also analyzed. Results: All patients and controls were of reproductive age (38 and 35, respectively). The 78.4% of patients had history of recurrent abortions and 40.5% of fetal losses. The most common positive antibodies were immunoglobulin anticardiolipin (G + M, 78%) and LA 42%. The prevalence of arterial and venous thrombosis was 21.6%, and of hypertension and hypercholesterolemia 13%. Levels of CEC, MP and TF were significantly increased in patients compared with controls. When patients were grouped by those suffering thrombosis and those without, MP levels showed a significant increase of 1.8 times higher in patients with thrombosis, and D-dimer and vWF of 1.6 and 1.5 times higher, respectively. No differences in markers of endothelial dysfunction were observed when patients were grouped by their positivity for LA, abortions and fetal losses. The levels of other laboratory tests analyzed were similar in patients and controls. Conclusions: Our study demonstrates the presence of a substantial risk of thrombotic events in women with history of obstetric antiphospholipid syndrome. In these patients, circulating CEC, MP, and TF as endothelial dysfunction biomarkers, showed relevant differences with the healthy women. Therefore, their determination may have some interest in the prediction of thrombotic risk, although these findings must be confirmed in further studies with a larger number of patients. C0572 ORAL CONTRACEPTIVE AND DEEP VENOUS THROMBOSIS (DVT) IN A DEPARTMENT OF INTERNAL MEDICINE F. Ajili1 , A. Laanani1 , W. Sassi1 , s. Sayhi1 , N. Boussetta1 , J. Laabidi1 , B. Louzir1 , N. Ben Abdelhafidh1 , S. Othmani1 . 1 Military hospital of Tunis, Tunisia Background: The incidence of venous thrombosis is low before age 40; it increases in women with combined oral contraceptives (COC). With these drugs, there is an hypercoagulable state, characterized by increased levels of fibrinogen, factor VII and factor X, and a decrease in the physiological coagulation inhibitor, antithrombin and protein S in plasma. Hyper-fibrinolysis is also observed with the increase of plasminogen and decrease rate of PAI-1 inhibitor (plasminogen activator), and acquired resistance to activated protein C. Methods: This is a retrospective study in a department of internal medicine, including records of patients hospitalized for DVT diagnosed between 2004 and 2013. The etiological investigation and research of a thrombophilia were performed in our patients. Results: Of 100 cases of DVT noted during the same period, 46 women had DVT, 6 cases (13%) of DVT occurred associated with the use of the COC were retained. There mean age was at 36 years (30–47 years). The mean BMI was 28 kg/m2 (50% of BMI > 30 kg/m2 ). Type II diabetes and a history of miscarriages were found in two patients each. A family history of DVT was noted in one patient. All patients were put on COC of second generation for an average of two years. There were no risk factors for thrombosis except the notion of varicose veins (3 cases). The topography of DVT was lower limbs with proximal location. One case was complicated by pulmonary embolism. The etiological investigation showed hyperhomocysteinemia (2 cases) and varicose veins (3 cases). All other investigations showed no abnormalities. Our patients were all put on anticoagulant therapy (mean duration 6 months), with good evolution without recurrence of thrombosis. The COC were stopped.
Conclusions: In addition to the need to focus on prescribing COC of second generation (norgestrel, levonorgestrel), it is important to remember the importance of seeking and trace risk factors for thrombosis before prescribing a COC to a “new patient”. C0601 ANTI-XA LEVELS IN PREGNANT WOMEN RECEIVING 5,000 IU DALTEPARIN DAILY M. Bozic Mijovski1 , M. Kozak1 . 1 University Medical Centre Ljubljana, Dpt. Vascular Diseases, Slovenia Background: Pregnant women at increased risk of venous thromboembolism usually receive thromboprophylaxis (lowmolecular weight heparin, LMWH) throughout pregnancy and postpartum. Regular laboratory monitoring of LMWH therapy with anti-Xa assay is not recommended, therefore, little is known about anti-Xa activity in this patient population. Methods: One hundred and twelve pregnant women receiving 5,000 IU dalteparin daily were included in the study. Blood was drawn at gestational weeks 5–10, 11–15, 16–20, 21–25, 26–30, 31–35 and 36–40 each time 4 hours after the last dalteparin dose and collected into vacuum tubes containing 0.11 M sodium citrate (Becton Dickinson, Vacutainer System Europe, Germany), centrifuged within 4 h of venepuncture at 4°C and 2000g for 30 minutes, snap frozen and stored at −70°C until analyzed. In all samples anti-Xa activity was measured with Berichrom Heparin (Siemens, Germany) on the CS2100i coagulation analyzer (Sysmex, Japan). Results: During pregnancy there was no significant fluctuation in the average anti-Xa activity (ANOVA p for anti-Xa between weeks of gestation was non-significant). However, there was wide variability in anti-Xa activity between patients (Table). About 20% of all pregnant women had anti-Xa levels already in the therapeutic range (0.50–1.00 IU/mL), and on two occasions even above 1.00 IU/mL. Table: Anti-Xa activity in pregnant women receiving 5,000 IU dalteparin daily Week of gestation
N
Arithmetic mean ± SD
Min-max
N (%) in therapeutic range a
5–10 11–15 16–20 21–25 26–30 31–35 36–40
15 52 47 60 57 64 35
0.38±0.21 0.39±0.19 0.36±0.17 0.33±0.16 0.32±0.15 0.35±0.18 0.34±0.20
0.00–0.77 0.00–0.80 0.00–0.69 0.00–0.72 0.00–0.66 0.00–1.09 0.04–1.16
3 (20) 13 (25) 10 (21) 10 (17) 6 (11) 11 (17) 5 (14)
a
Anti-Xa >0.50 IU/mL.
Conclusions: We reported a wide range of anti-Xa activity in pregnant women receiving prophylactic doses of dalteparin. The efficacy of LMWH prophylaxis according to anti-Xa activity should be established in further studies.