AMBULATORY VENOUS THROMBOEMBOLISM CRITICAL MANIFESTATIONS AND ETIOLOGIES

Objectives: Venous stasis in bedridden patients is recognized as one of the risk factors for venous thromboembolism but the phenomena is known to occur in ambulatory subjects and another cause must be involved. We investigated a series of consecutive ambulatory patients with venous thromboembolism in order to distinguish the particular clinical manifestations and possible aetiologies. Methods: We compared a retrospective series of 120 consecutive patients with deep vein thromboembolism of the lower limbs and 127 patients with the same disease who had been bedridden at onset. In addition to the physical examination, the aetiological work-up included echography (n=14), abdominal computed tomography (n=38) and/or haemostasis studies (n=61). Mean follow up was 23+/-13 months (range 1-45 months). Results: Family history of deep venous thromboembolism was found in 17 patients and recurrence was observed in 50 patients. Phlebitis was on the right in 52 cases, on the left in 47 and bilateral in 17. Proximal locations were more frequent (74%) and pulnonary embolism occurred in one-half of the patients (n=58). A cause was identified in 61 cases (50.8%): cancer (n=24, 17 known, 7 previously unknown), dyscrasia (n=17, protein 8 or C deficiency (5), increased plasminogen activator inhibitor I (8), circulating anticoagulants (3), hypofibrinogen (1), idiopathic varicose veins (n=7), pregnancy (n=5), oral contraceptives (n=4) and other causes (n=4). No cause was identified in 59 patients. Pulmonary embolism led to death in 4 cases. Seven patients were lost to follow-up and anticoagulation therapy was taken by 79 (72%) then interrupted in the others 3 to 6 months later. Eighteen patients died, 14 due to the underlying disease, 2 from new cancers and 12 after recurrent thromboembolism. Conclusion: Ambulatory venous embolism is as frequent as embolism in bedridden patients and the cause can be observed in 50% of tbe cases.