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Factor V Leiden Mutation in Postthrombotic and Non-postthrombotic Venous Ulcers
Jürg Hafner, MD;
Andreas Kühne, MD;
Beatrice Schär, PhD;
Thomas Bombeli, MD;
Markus Hauser, MD;
René Lüthi, MD;
Edgar Hänseler, MD
Arch Dermatol. 2001;137:599-603.
Objective To determine the prevalence of the factor V Leiden mutation in patients with postthrombotic and non-postthrombotic venous ulcers.
Design Case-control study.
Setting Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
Participants Seventy-three consecutive outpatients and inpatients with venous ulcers and 45 age- and sex-matched control subjects (matched to the 42 patients with postthrombotic syndrome).
Main Outcome Measures Frequency of postthrombotic and non-postthrombotic findings in patients with venous ulcers. Prevalence of the factor V Leiden mutation in these different subgroups.
Results Postthrombotic syndrome was identified as the cause of 42 (58%; 95% confidence interval [CI], 45%-69%) of 73 venous ulcers, and the remainder were caused by primary valvular insufficiency. In postthrombotic ulcers, the prevalence of the factor V Leiden mutation was 38% (95% CI, 24%-54%) (16/42), which corresponds to an odds ratio of 13.2 (95% CI, 2.8-62.3; P<.001). In non-postthrombotic venous ulcers, the prevalence was 16% (95% CI, 5%-34%) (5/31), which corresponds to an odds ratio of 3.2 (95% CI, 1.0-10.0; P = .07).
Conclusions The factor V Leiden mutation is highly prevalent in patients with postthrombotic venous ulcers. Even patients with non-postthrombotic venous ulcers show a moderately elevated prevalence of the factor V Leiden mutation. Some of the latter might be misclassified because of near-to-perfect revascularization after asymptomatic deep venous thrombosis. However, as long as the therapeutic consequences of the factor V Leiden mutation are not established, systematic screening cannot be recommended in patients with venous ulcers.
From the Department of Dermatology (Drs Hafner and Kühne), the Institute of Clinical Chemistry (Drs Schär and Hänseler), the Haemostasis Unit, Division of Haematology and Haemostasis, Department of Internal Medicine (Dr Bombeli), the Institute of Diagnostic Radiology (Dr Hauser), and the Division of Angiology, Department of Internal Medicine (Dr Lüthi), University Hospital of Zurich, Zurich, Switzerland.
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