RSS Feeds
Risk Factors for Deep Venous Thrombosis of the Upper Extremities
- Deepti Pandita, MD;
- Preston Steen, MD; and
- Anil Potti, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Deepti Pandita, MD
Preston Steen, MD
Anil Potti, MD
University of North Dakota; Fargo, ND 58102
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
