REPLY
Reply: Risk Factors for Deep Venous Thrombosis of the Upper Extremities
Ida Martinelli, MD;
Marco Cattaneo, MD; and
Pier Mannuccio Mannucci, MD
15 December 1997 | Volume 127 Issue 12 | Page 1129
IN RESPONSE:
Pandita and colleagues suggest that patients with unusual sites of venous thrombosis, such as the upper extremities, should be screened for factor XII deficiency, which they consider to be a rare but important cause of thrombophilia. In our study, we showed that the prevalence of several causes of thrombophilia is not increased in patients with deep venous thrombosis of the upper extremities; the most frequent and important risk factor for this condition is a recent history of strenuous exercise of muscles of the affected extremity. In light of our findings, thrombophilic states of any kind should not be sought in patients with deep venous thrombosis of the upper extremities.
Whether factor XII deficiency is a thrombophilic state is still uncertain because the evidence published to date is mostly anecdotal and conflicting [1-4]. Considering this uncertainty and the rarity of the disease, and having the option of screening patients with an activated partial thromboplastin time assay that is very sensitive to plasma levels of factor XII, our policy is to measure factor XII in thrombophilic patients only if 1) the most common risk factors for venous thrombosis are absent; 2) the activated partial thromboplastin time is prolonged; and 3) lupus anticoagulant, which could account for prolongation of the activated partial thromboplastin time, is absent. None of our 36 patients with deep venous thrombosis of the upper extremities and none of our 121 patients with deep venous thrombosis of the lower extremities had such characteristics.
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Author and Article Information
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IRCCS Ospedale Maggiore; Milano, Italy
1. von Kanel R, Wuillemin WA, Furlan M, Lammle B. Factor XII clotting activity and antigen levels in patients with thromboembolic disease. Blood Coagul Fibrinolysis. 1992; 3:555-61.
2. Lammle B, Wuillemin WA, Huber I, Krauskopf M, Zurcher C, Pflugshaupt R, et al. Thromboembolism and bleeding tendency in congenital factor XII deficiency. A study on 74 subjects from 14 Swiss families. Thromb Haemost. 1991; 65:117-21.
3. Rodeghicro F, Castaman G, Ruggeri M, Tosetto A. Thrombosis in subjects with homozygous and heterozygous factor XII deficiency. Thromb Haemost. 1992; 67:590.
4. Winter M, Gallimore M, Jones DW. Should factor XII assay be included in thrombophilia screening? [Letter] Lancet. 1995; 346:52.
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