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• W2000380123 abstract "Pulmonary embolism (PE) and deep venous thrombosis (DVT) are thought to represent two clinical manifestations of the same disease [1]. Approximately 90% of symptomatic pulmonary emboli arise from thrombi located in the leg veins [2]. Most patients with symptomatic DVT have extensive occlusive proximal vein thrombosis at the time of presentation [3]. Studies focusing on the location of DVT and the risk of a subsequent PE show that DVTs located in the proximal veins are especially associated with PE [4, 5], while isolated calf vein thrombosis results less often in an embolic event [6, 7]. In patients presenting with acute pulmonary embolism, the incidence of the factor V Leiden (FVL) mutation appears to be half of that reported in patients presenting with acute deep vein thrombosis [8, 9]. As a possible explanation of the weak association between FVL and isolated PE it is suggested that carriers of the mutation develop proximal (iliofemoral) DVT less frequently than non-carriers [10]. However, other studies find contradicting frequencies [11, 12]. We studied consecutive patients with venography proven DVT, referred to an Italian university hospital between 1986 and 1994. Concomitant clinical symptoms of PE were not confirmed by objective tests because the presence of PE had no therapeutic consequences. Venograms were independently assessed for level and extent of thrombosis. Our intension was to compare the venous segments that are at highest risk of PE (the common femoral and/or iliac vein) to the other venous segments. Patients were not classified as having proximal or distal DVT, but as having the iliofemoral tract (by definition the one at highest risk of PE) involved or not. DVT confined to the calf vein system and that extending proximally up to the femoral veins, but without involving the iliac veins, was considered more distally localized; localization in the whole deep vein system (from calf up to iliac veins) and isolated DVT in the femoral and/or iliac veins, but not associated with calf vein involvement, was considered more proximally localized. Out of 850 patients who had the phlebographic diagnosis of DVT, we were able to retrieve 630 patients for FVL screening. Of these, 528 gave their informed consent. This study was approved by a medical ethics committee. The study population comprised 528 patients. Heterozygous FVL was found in 51 patients (9.7%). The mean age of the patients was 63 (5–95% percentile 29–83); 294 (56%) of the patients were male. Concomitant pulmonary embolism was suspected in six of the 51 carriers of FVL (11.8%) and in 72 of the 477 non-carriers (15.1%). Results of the venograms are displayed in Table 1. In the 264 patients with more proximal localization of DVT, the incidence of FVL was 6.4% [95% CI 3.8–10.1], whereas in the 264 patients with more distal localization the incidence was 13% (95% CI: 9.1–17.5), with the difference being 6.4% (95% CI: 1.4–11.4%, P = 0.02). When using a more conventional definition of proximal (popliteal veins and above) and distal localization (isolated calf veins only), there was no significant difference between both groups (P = 0.56). Of note, the number of FVL carriers in our cohort was low (9.7%) compared with other studies among patients with venous thrombosis from Italy (22–33% [11, 13]). However, the incidence of FVL is four times as high as that expected in the general population (2.5% [14]). A possible explanation may be that a selection has occurred in our patient population, as 25% of the patients could not be retrieved for FVL screening. Otherwise, we have no obvious explanations for these findings. Nonetheless, we do not consider this to have influenced our study results. This large study demonstrates that the presence of heterozygous FVL mutation is associated with a significantly lower rate of involvement of the more proximal veins, which have been found to be associated with a higher rate of PE [4]. Our data add to evidence from published studies demonstrating that FVL is only weakly associated with PE by a less proximal localization of DVT. The authors state that they have no conflict of interest." @default.
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• W2000380123 date "2008-03-01" @default.
• W2000380123 modified "2023-09-30" @default.
• W2000380123 title "Factor V Leiden is associated with more distal location of deep vein thrombosis of the leg" @default.
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• W2000380123 doi "https://doi.org/10.1111/j.1538-7836.2007.02883.x" @default.
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