Thrombophilia in patients with venous ulcers

Background: The prevalence of the factor V Leiden mutation in patients with venous ulcers is 23-26%. The present study investigates the prevalence of thrombophilia-associated factors of coagulation in patients with venous ulcers with and without postthrombotic syndrome. Patients and methods: Case-control study in 73 consecutive patients with venous ulcers and 45 controls. Patient history, duplex sonography or phlebography. The following parameters of coagulation have been determined in all subjects: Antithrombin III, protein C, protein S, factor V Leiden mutation, prothrombin mutation (G20210A), lupus anticoagulant, anticardiolipin antibodies, homocystein level, and methylenetetrahydrofolatereductase (MTHFR) mutation (677T). Results: 42 patients with postthrombotic syndrome: 52% (p = 0.001) had at least one, 33% a combination of two (p = 0.001) and additional 14% three thrombophilia-associated factors (p = 0.0002). The factor V Leiden mutation was prevalent in 38% (p = 0.0001). Patients with primary venous insufficiency (without proven postthrombotic syndrome): 39% (p = 0.14) had at least one, 3% (p = 1.0) a combination of two and 0% a combination of three thrombophilia-associated factors. The factor V Leiden mutation was prevalent in 16% (p = 0.11). Conclusion: Coagulation factors associated with thrombophilia are strongly elevated in patients with with postthrombotic venous ulcers. Combinations of the so-called classical thrombophilia factors are found in 47%. Nevertheless, routine investigations for thrombophilia are discouraged because of the lack of consequences and high costs.