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P-079: Ovarian vein thrombosis case series review at King Fahad Medical City in Riyadh, Saudi Arabia
Abstracts / Thrombosis Research 151, Suppl. 1 (2017) S103–S140
28.2%, p<0.0001); lower specificity (57.1% versus 81.0%, p<0.0001) and better LHR (+LHR 1.77 versus 1.48, p<0.001 and −LHR 0.42 versus 0.89, p<0.001). Conclusions: TiC proved to have a better discriminative and predictive capacity to identify female patients who would suffer a VTE event than the classic F5L and PT algorithm.
P-076 A successful pregnancy in a woman with late-onset combined homocystinuria and methylmalonic aciduria E. Grandone, G. Vecchione, G.M. Maruotti, M. Villani, A. Leccese, R. Santacroce, G. Corso, P. Martinelli, M. Margaglione Throsmbosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy Cobalamin C (CblC) defects are inherited autosomal recessive disorders of vitamin B12 metabolism, with an unknown true prevalence. We describe the case of a 34 yrs-old Caucasian woman from Southern Italy, referred because of a 20th week pregnancy loss of a morphologically normal intrauterine growth restricted foetus. Then she performed a thrombophilia screening, that showed 100 microM of plasma homocysteine. At that time she was on folic acid (calcium folinate, 15 mg/day). She was delivered at term and was in apparently good health until 20 yrs, when she showed a normocitic anemia (Hb: 8.2 g/dL), elevated inflammatory markers (ESR 55), and an impaired renal function (serum creatinine: 1.9 mg/dL). Urinalysis revealed proteinuria (150 mg/L) and micro-hematuria. At that time she was found to be moderately hypertensive. Neurological examination was normal. A renal biopsy revealed thrombotic microangiopathy with predominant lesions in the glomerulus and minimal lesions in the arterioles. Whole Exome Sequencing showed a compound heterozygosity for p. Tyr130His and p.Tyr222Stop in the MMACHC gene (Methylmalonic Aciduria type C and Homocystinuria; OMIM *609831). Plasma concentration of methylmalonic acid was 1.09 micromol/L (reference value: 0–0.7). Hydroxocobalamin injection, 2 mg/week i.m., normalized tHcy plasma levels and restored anemia and renal function. Pregnancy was then started and lowmolecular weigh heparin at prophylactic doses prescribed in addition to hydroxocobalamin until 4 weeks post-partum. After an uneventful pregnancy, a male baby weighing 2420 gr (Apgar 1’ 8, 10’: 9) was delivered at 39 weeks. To our knowledge, this is the first case of pregnancy described in a CblC defect.
P-077 Risk of recurrence of venous thromboembolism in patients with gynaecological cancer Z. Marchocki 1,2 , F. Abu Saadeh 2 , N. Gleeson 1,2 , L. Norris 1 Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences; 2 Department of Gynaecology Oncology St. James’s Hospital, Dublin, Ireland
S133
Conclusion: Patients with gynaecological cancer treated for VTE remain at high risk of recurrent venous thrombosis despite standard anticoagulation treatment.
P-078 Pregnancy and venous thromboembolism: a case series analysis of clinical presentation, diagnosis, thrombophilia, treatment and outcome M.A. Alsheef 1 , A.M. Alabbad 0 , R.A. Albassam 0 , R.M. Alarfaj 2 1 Internal Medicine Consultant, King Fahad Medical City, Riyadh Saudi Arabia; 2 Pharm. D. Candidates, Collage of Pharmacy, Princess Norah University, Riyadh, Saudi Arabia Background: Pregnancy is one of the major risk factors for development of venous thromboembolism (VTE). Objective: We conducted this study to comprehensively describe the patterns surrounding pregnancy-induced venous thromboembolism (DVT and PE), potential thrombosis triggering factors (thrombophilia, obesity, age, parity, family history, etc.), initial and long term management, recurrence and mortality rate of VTE among Saudi pregnant population. Methods: A retrospective descriptive chart review of 180 patients with objectively confirmed VTE (DVT, PE or both), provoked by pregnancy or postpartum period was done. We included all patients who experienced one or more episodes of objectively confirmed VTE during pregnancy or postpartum period. Descriptive analysis was done. Results: Among all VTE cases, 67% experienced provoked VTE (67%), among those, pregnancy was the most common provoking factor which was observed in 33% of our patients exceeding other well-known provoking factors. Obesity was observed in 40% of our patients. Multiparity was the second prevalent risk factor 32.2%, followed by medical comorbidities such as DM & hypertension, age >35, family history and personal history of VTE (31.1%, 29.4%, 19.4% and 18.3% respectively). Other risk factors were varicose veins (14.4%), thrombophilia (17%), multiple pregnancies or assisted reproductive therapy (9.4%) and previous recurrent VTE (7.2%). Conclusion: Pregnancy was the most frequent provoking factor for VTE, exceeding other transient risk factors. Therefore, all pregnant women should undergo a formal, written risk assessment of risk factors for VTE at booking and at delivery. Further larger studies using randomized design and control groups need to be conducted to confirm the result of our study
P-079 Ovarian vein thrombosis case series review at King Fahad Medical City in Riyadh, Saudi Arabia M. Alsheef 1 , A. Altamimi 2 , A. Alfayez 2 , M. Alosaimi 2 , A. Mashi 2 Internal Medicine Consultant, King Fahad Medical City, Riyadh, Saudi Arabia; 2 Medical residents, King Fahad Medical City, Riyadh, Saudi Arabia
1
1
Introduction: Patients with cancer have a high risk of developing venous thromboembolism (VTE). Gynaecological cancers are among the highest risk cancer groups with incidence rates of 5–16% for VTE. The incidence of recurrence of VTE in not established for women with genital tract malignancy. The aim of this study was to define the incidence of VTE recurrence in patients with gynaecological cancer. Patients and study design: This was a retrospective cohort study on patients with gynaecological cancer treated in St James’s Hospital Gynaecologic Oncology Centre between 2006 and 2016. Patients with cancer related VTE were identified from hospital and general practice medical records and the incidence of recurrence was recorded. Demographic data, histology, stage, surgery, chemotherapy, co-morbidities and timing of primary and recurrent VTE episodes were recorded. Results: 104 gynaecologic cancer patients who had VTE were identified from the database. Standard anticoagulation was with low molecular weight heparin for 3–6 months. VTE recurred in 20 (19%) patients with ovarian (9/60, 15%), uterine (9/32, 28%) and cervical (2/9, 22%) cancers. Fourteen (70%) recurrent VTE events occurred within 6 months of their primary VTE and twelve patients were still on therapeutic dose of LMWH. Sixteen (80%) patients in the recurrent group had open surgery. Four (20%) were receiving chemotherapy at the time of VTE recurrence.
Objective: Presented is a case series of ovarian vein thrombosis (OVT) cases occurring in our community in a single centre with a goal to identify disease characteristics, demographics, symptoms and signs, risk factors, treatment and outcome. Subjects and methods: Data of 18 cases of ovarian vein thrombosis collected using a standardized case report form (CRF). Inclusion criteria were patients diagnosed with ovarian vein thrombosis confirmed by Doppler ultrasonography, computed tomography or magnetic resonance imaging. Exclusion criterion was missing patients’ hospital chart. Results: Our findings were consistent with previous similar case series. OVT was more commonly involving right ovarian vein, mainly occurring in women during postnatal period. Hypertension, diabetes, and high BMI were common risk factors of the disease. Most common presenting symptoms identified were abdominal pain followed by fever. Enoxaparin was the most commonly used treatment of 1–3 months duration with a very low recurrence rate. Conclusion: OVT is a rare condition and is under-reported in our community. Due to the possible life threatening complications of the disease, physicians should be vigilant of when to suspect the disease, be aware of how the disease manifests, and understand the best diagnostic modalities and treatment options.
28.2%, p<0.0001); lower specificity (57.1% versus 81.0%, p<0.0001) and better LHR (+LHR 1.77 versus 1.48, p<0.001 and −LHR 0.42 versus 0.89, p<0.001). Conclusions: TiC proved to have a better discriminative and predictive capacity to identify female patients who would suffer a VTE event than the classic F5L and PT algorithm.
P-076 A successful pregnancy in a woman with late-onset combined homocystinuria and methylmalonic aciduria E. Grandone, G. Vecchione, G.M. Maruotti, M. Villani, A. Leccese, R. Santacroce, G. Corso, P. Martinelli, M. Margaglione Throsmbosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy Cobalamin C (CblC) defects are inherited autosomal recessive disorders of vitamin B12 metabolism, with an unknown true prevalence. We describe the case of a 34 yrs-old Caucasian woman from Southern Italy, referred because of a 20th week pregnancy loss of a morphologically normal intrauterine growth restricted foetus. Then she performed a thrombophilia screening, that showed 100 microM of plasma homocysteine. At that time she was on folic acid (calcium folinate, 15 mg/day). She was delivered at term and was in apparently good health until 20 yrs, when she showed a normocitic anemia (Hb: 8.2 g/dL), elevated inflammatory markers (ESR 55), and an impaired renal function (serum creatinine: 1.9 mg/dL). Urinalysis revealed proteinuria (150 mg/L) and micro-hematuria. At that time she was found to be moderately hypertensive. Neurological examination was normal. A renal biopsy revealed thrombotic microangiopathy with predominant lesions in the glomerulus and minimal lesions in the arterioles. Whole Exome Sequencing showed a compound heterozygosity for p. Tyr130His and p.Tyr222Stop in the MMACHC gene (Methylmalonic Aciduria type C and Homocystinuria; OMIM *609831). Plasma concentration of methylmalonic acid was 1.09 micromol/L (reference value: 0–0.7). Hydroxocobalamin injection, 2 mg/week i.m., normalized tHcy plasma levels and restored anemia and renal function. Pregnancy was then started and lowmolecular weigh heparin at prophylactic doses prescribed in addition to hydroxocobalamin until 4 weeks post-partum. After an uneventful pregnancy, a male baby weighing 2420 gr (Apgar 1’ 8, 10’: 9) was delivered at 39 weeks. To our knowledge, this is the first case of pregnancy described in a CblC defect.
P-077 Risk of recurrence of venous thromboembolism in patients with gynaecological cancer Z. Marchocki 1,2 , F. Abu Saadeh 2 , N. Gleeson 1,2 , L. Norris 1 Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences; 2 Department of Gynaecology Oncology St. James’s Hospital, Dublin, Ireland
S133
Conclusion: Patients with gynaecological cancer treated for VTE remain at high risk of recurrent venous thrombosis despite standard anticoagulation treatment.
P-078 Pregnancy and venous thromboembolism: a case series analysis of clinical presentation, diagnosis, thrombophilia, treatment and outcome M.A. Alsheef 1 , A.M. Alabbad 0 , R.A. Albassam 0 , R.M. Alarfaj 2 1 Internal Medicine Consultant, King Fahad Medical City, Riyadh Saudi Arabia; 2 Pharm. D. Candidates, Collage of Pharmacy, Princess Norah University, Riyadh, Saudi Arabia Background: Pregnancy is one of the major risk factors for development of venous thromboembolism (VTE). Objective: We conducted this study to comprehensively describe the patterns surrounding pregnancy-induced venous thromboembolism (DVT and PE), potential thrombosis triggering factors (thrombophilia, obesity, age, parity, family history, etc.), initial and long term management, recurrence and mortality rate of VTE among Saudi pregnant population. Methods: A retrospective descriptive chart review of 180 patients with objectively confirmed VTE (DVT, PE or both), provoked by pregnancy or postpartum period was done. We included all patients who experienced one or more episodes of objectively confirmed VTE during pregnancy or postpartum period. Descriptive analysis was done. Results: Among all VTE cases, 67% experienced provoked VTE (67%), among those, pregnancy was the most common provoking factor which was observed in 33% of our patients exceeding other well-known provoking factors. Obesity was observed in 40% of our patients. Multiparity was the second prevalent risk factor 32.2%, followed by medical comorbidities such as DM & hypertension, age >35, family history and personal history of VTE (31.1%, 29.4%, 19.4% and 18.3% respectively). Other risk factors were varicose veins (14.4%), thrombophilia (17%), multiple pregnancies or assisted reproductive therapy (9.4%) and previous recurrent VTE (7.2%). Conclusion: Pregnancy was the most frequent provoking factor for VTE, exceeding other transient risk factors. Therefore, all pregnant women should undergo a formal, written risk assessment of risk factors for VTE at booking and at delivery. Further larger studies using randomized design and control groups need to be conducted to confirm the result of our study
P-079 Ovarian vein thrombosis case series review at King Fahad Medical City in Riyadh, Saudi Arabia M. Alsheef 1 , A. Altamimi 2 , A. Alfayez 2 , M. Alosaimi 2 , A. Mashi 2 Internal Medicine Consultant, King Fahad Medical City, Riyadh, Saudi Arabia; 2 Medical residents, King Fahad Medical City, Riyadh, Saudi Arabia
1
1
Introduction: Patients with cancer have a high risk of developing venous thromboembolism (VTE). Gynaecological cancers are among the highest risk cancer groups with incidence rates of 5–16% for VTE. The incidence of recurrence of VTE in not established for women with genital tract malignancy. The aim of this study was to define the incidence of VTE recurrence in patients with gynaecological cancer. Patients and study design: This was a retrospective cohort study on patients with gynaecological cancer treated in St James’s Hospital Gynaecologic Oncology Centre between 2006 and 2016. Patients with cancer related VTE were identified from hospital and general practice medical records and the incidence of recurrence was recorded. Demographic data, histology, stage, surgery, chemotherapy, co-morbidities and timing of primary and recurrent VTE episodes were recorded. Results: 104 gynaecologic cancer patients who had VTE were identified from the database. Standard anticoagulation was with low molecular weight heparin for 3–6 months. VTE recurred in 20 (19%) patients with ovarian (9/60, 15%), uterine (9/32, 28%) and cervical (2/9, 22%) cancers. Fourteen (70%) recurrent VTE events occurred within 6 months of their primary VTE and twelve patients were still on therapeutic dose of LMWH. Sixteen (80%) patients in the recurrent group had open surgery. Four (20%) were receiving chemotherapy at the time of VTE recurrence.
Objective: Presented is a case series of ovarian vein thrombosis (OVT) cases occurring in our community in a single centre with a goal to identify disease characteristics, demographics, symptoms and signs, risk factors, treatment and outcome. Subjects and methods: Data of 18 cases of ovarian vein thrombosis collected using a standardized case report form (CRF). Inclusion criteria were patients diagnosed with ovarian vein thrombosis confirmed by Doppler ultrasonography, computed tomography or magnetic resonance imaging. Exclusion criterion was missing patients’ hospital chart. Results: Our findings were consistent with previous similar case series. OVT was more commonly involving right ovarian vein, mainly occurring in women during postnatal period. Hypertension, diabetes, and high BMI were common risk factors of the disease. Most common presenting symptoms identified were abdominal pain followed by fever. Enoxaparin was the most commonly used treatment of 1–3 months duration with a very low recurrence rate. Conclusion: OVT is a rare condition and is under-reported in our community. Due to the possible life threatening complications of the disease, physicians should be vigilant of when to suspect the disease, be aware of how the disease manifests, and understand the best diagnostic modalities and treatment options.