Haematologica 2004;89: supplement no. 8 - Supplements ...

66Oral Communicationsspontaneous recurrent VTE was noticed in any groupin comparison with the reference individuals: thehazard ratio was 1.9 (95% CI 0.9-4.2) in the groupA (aPL), 1.2 (95% CI 0.8-1.8) in the group B (inheritedthrombophilia), and 0.8 (95% CI 0.2-2.8) in thegroup C (both aPL and inherited thrombophilia).Patients with aPL (group A), in spite of the observationtime shorter than that of the reference group D(median 2 years versus 4 years), showed a moderate1.9-fold increase in risk for recurrent VTE. However,the presence of aPL does not seem to increase tendencytowards VTE among patients with inheritedthrombophilia.CO-089D-DIMER AND VENOUS THROMBOTIC RESIDUE AREINDEPENDENT RISK FACTORS FOR RECURRENT VENOUSTHROMBOEMBOLISM AFTER ANTICOAGULATION WITHDRAWALCosmi B, Legnani C, Cini M, Guazzaloca G, Valdrè L,Brusi C, Palareti GDept. of Angiology & Blood Coagulation “MarinoGolinelli”, University Hospital S. Orsola-Malpighi,Bologna, ItalyIntroduction. D-dimer (D-d) and venous thromboticresidue (VTR) have been separately shown to berisk factors for recurrent VTE. Aims: to assess thepredictive value of the combination of D-d and VTRfor the development of recurrent VTE. Methods. 704consecutive symptomatic patients with a firstepisode of proximal deep vein thrombosis of the lowerlimbs were enrolled on the day of OAT withdrawal(T1). At T1 and three months afterwards (T3), D-dlevels were measured and VTR was determined bycompression ultrasonography. D-d was also measuredafter 30+10 days (T2). All the three availablemeasurements of D-d were considered to establish atrend (D-d trend): abnormal if D-d was persistentlyabove the cut-off value (75th percentile of the D-dvalues at T1 according to type of index event) at T1,T2 and T3 or if it increased above cut-off values atT2 and/or T3. Recurrences were diagnosed in case ofsymptoms of VTE by objective methods during a 2-year period. Results. Abnormal D-d trend was presentin 59.7% and VTR in 51.9% of patients. AbnormalD-d trend and VTR were associated with a multivariatehazard ratio for recurrence of 2.29 (95% CI:1.29-4.06; p=0.004) and 1.84 (95% CI: 1.15-2.95;p=0.011) respectively. When compared with patientswith normal D-d trend and absent VTR, the hazardratio for recurrence associated with abnormal D-dtrend and VTR was 6.36 (95% CI: 2.21-18.33; p=0.001) in all patients after adjustment for sex, age,OAT duration, thrombophilia, type of index event andcancer and 4.95 (95% CI: 1.45-16.89; p= 0.011) inpatients with an idiopathic DVT after adjustment forsex, age, OAT duration and thrombophilia. Conclusions:D-d and VTR are independent risk factors forrecurrent VTE.SISET PrizeCO-090RISK FACTORS AND RECURRENCE RATE OF PRIMARY DEEPVEIN THROMBOSIS OF THE UPPER EXTREMITIESBattaglioli T, Martinelli I, Bucciarelli P,Passamonti SM, Mannucci PMAngelo Bianchi Bonomi Hemophilia and ThrombosisCenter, Department of Internal Medicine and Dermatology,IRCCS Maggiore Hospital, University ofMilan, ItalyOne third of cases of upper-extremity deep veinthrombosis (DVT) are primary, i.e, they occur in theabsence of central venous catheters or cancer. Riskfactors for primary upper-extremity DVT are not wellestablished, and the recurrence rate is unknown. Westudied 115 primary upper-extremity DVT patientsand 797 healthy controls for the presence of thrombophiliadue to factor V Leiden, prothrombinG20210A, antithrombin, protein C, protein S deficiencyand hyperhomocysteinemia. Transient riskfactors for venous thromboembolism were recorded.Recurrent upper-extremity DVT was prospectivelyevaluated over a median period of 5.1 years of follow-up.The adjusted odds ratio for upper extremityDVT was 6.2 (95% CI 2.5-15.7) for factor V Leiden,5.0 (95% CI 2.0-12.2) for prothrombin G20210A and4.9 (95% CI 1.1-22.0) for the anticoagulant proteindeficiencies. Hyperhomocysteinemia and oral contraceptiveswere not associated with upper-extremityDVT. However, in women with factor V Leiden orprothrombin G20210A taking oral contraceptives, theodds ratio for upper-extremity DVT was increased upto 13.6 (95% CI 2.7-67.3). The recurrence rate was4.4% patient-years in patients with and 1.6%patient-years in those without thrombophilia. Thehazard ratio for recurrent upper-extremity DVT inpatients with thrombophilia compared to thosewithout was 2.7 (95% CI 0.7-9.8). In conclusion,inherited thrombophilia is associated with anincreased risk of upper-extremity DVT. Oral contraceptivesincrease the risk only when combined withinherited thrombophilia. The recurrence rate of primaryupper-extremity DVT is low, but tends to behigher in patients with thrombophilia than in thosewithout.haematologica vol. 89(suppl. n. 8):september 2004