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PubMed2002

[Clinically non-symptomatic pulmonary embolism in patients with deep vein thrombosis of the lower limb].

The pulmonary embolism (PE) is the common and severe complication of the deep vein thrombosis of the lower limbs. The lack of accurate diagnosis of PE is a cause of 5-10% of the hospital deaths. The aim of the study was to assess the incidence of the pulmonary embolism in patients with the deep vein thrombosis of the lower limbs with no clinical symptoms of pulmonary embolism. Pulmonary perfusion scintigraphy was performed in 25 patients with angiographic findings confirmative to the deep vein thrombosis of the lower limbs. The results of the study were analysed according to the PIOPED criteria. In the group of patients with common thrombosis of the deep vein a high probability of lung embolism was assessed in 70%, medium and low by 12% in each group, and very low in 6%. In the group of patients with femoral thrombosis of the deep vein a high probability of lung embolism was assessed in 60%, medium in 20% and very low in 20%. In the group of patients with calf thrombosis of the deep vein high, medium and very low probability of lung embolism was assessed by 25% in each group. Results of this study indicate the need of searching the pulmonary embolism in patients with thrombosis of the deep vein of the lower limbs despite the lack of clinical symptoms of the pulmonary embolism.

Adult↗
PubMed2002

New aspects of the blood coagulation cascade, anticoagulants and vein thrombosis in Asia.

PURPOSE: This review describes recent views on blood coagulation and abnormalities of its physiological control that predispose to thrombosis, suggests that venous thrombosis and pulmonary embolism are more prevalent in Asia than was previously thought, and examines recent trials of novel anticoagulants for thrombosis prevention. SOURCES: 'Medline' was used to search for publications in English or with English language abstracts. CONTENT AND CONCLUSIONS: The study of blood coagulation is basic to understanding clotting and bleeding disorders, their prevention and treatment. Tissue factor, factor Xa, and thrombin are pivotal; together with physiological controls (positive and negative feedback loops, and natural anticoagulants) that first enhance thrombin generation but then preserve vessel patency by limiting haemostatic plug formation to areas of injury. Abnormalities in these mechanisms can increase thrombosis risk (thrombophilia). The traditional impression that venous thromboembolism is rare in Asia has been reinforced by the rarity of thrombophilic genetic polymorphisms outside of European populations. Nevertheless, there is increasing evidence for an increasing prevalence of symptomatic vein thrombosis and pulmonary embolism in Asia, and that thrombosis rates in 'high risk' clinical settings among elderly patients (as after major joint surgery or a stroke) now approach levels reported from the West. This indicates the need for greater clinical awareness of these conditions. Drugs now used routinely for thrombosis prevention in the West (especially low molecular weight heparins) are effective and relatively safe. New anticoagulants were even more effective in recent trials. There is urgent need for studies in Asia that define the locally relevant benefits and hazards of the increasing range of agents now available.

Adult↗
PubMed2000

[Intraventricular thrombosis complicating peri-partum idiopathic myocardiopathy].

Ventricular thrombosis can complicate the development and worsen the prognosis in any case of hypokinetic dilated cardiomyopathy. In the present article, a study has been made of 6 reports of ventricular thrombosis selected out of 58 medical files on women with peri-partum idiopathic cardiomyopathy. Patient age ranged from 22 to 55 years. The clinical picture showed hypokinetic dilated cardiomyopathy, complicated by cardiac failure; with its onset during the last trimester of gestation or in the 6 months post-partum. In all patients, overall cardiac failure was observed, and in all cases the diagnosis of intracardiac thrombosis was made by echocardiography. In all 6 patients, a left ventricular apical thrombosis was detected. In 2 subjects, 2 and 3 left ventricular thrombi were respectively found. In 1 case, a left ventricular thrombosis was present. In another case, a right thrombosis associated with a left ventricular thrombosis was detected. Treatment was initiated with a combination of anticoagulants (heparin and K antivitamins), diuretic and vasodilatory treatment. The clinical outcome was favorable, with the disappearance of thrombi and signs of cardiac failure (between the 15th and 54th day). No embolic complication was observed. These findings clearly show the importance of prescribing an anticoagulant treatment as a preventive measure during PPICM. Even if severe embolic complications are a potential risk, anitcoagulant treatment can ensure a favorable outcome.

Adult↗
PubMed2003

Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use.

Deep vein thrombosis (DVT) is a common disease with an annual incidence of about 1 in 1000. Many risk factors have already been studied, both genetic and acquired. It is unclear whether obesity affects thrombotic risk in unselected patients. Obesity is common, with a prevalence of 20-25% and may therefore have a considerable impact on the overall incidence of thrombosis. We evaluated the risk of thrombosis due to overweight and obesity using data from a large population based case-control study. Four hundred and fifty-four consecutive patients with a first episode of objectively diagnosed thrombosis from three Anticoagulation Clinics in the Netherlands were enrolled in a case-control study. Controls were matched on age and sex to patients and were introduced by the patients. All patients completed a standard questionnaire and interview, with weight and height measured under standard conditions. The associations of obesity with clotting factor levels were studied to investigate possible mechanisms. Obesity (BMI >/=30 kg/m(2)) increased the risk of thrombosis twofold (CI95: 1.5 to 3.4), adjusted for age and sex. Obese individuals had higher levels of factor VIII and factor IX, but not of fibrinogen. The effect on risk of obesity was not changed after adjustment for coagulation factors levels (fibrinogen, F VIII, F IX, D-dimer). The relative risk estimates were similar in different age groups and in both sexes, indicating a larger absolute effect in older age groups. Evaluation of the combined effect of obesity and oral contraceptive pills among women aged 15-45 revealed that oral contraceptives further increased the effect of obesity on the risk of thrombosis, leading to 10-fold increased risk amongst women with a BMI greater than 25 kg/m(2) who used oral contraceptives. Obesity is a risk factor for deep vein thrombosis. Among women with a BMI greater than 25 kg/m(2) the synergistic effect with oral contraceptives should be considered when prescribing these.

Adolescent↗
PubMed1992

Anticardiolipin antibodies and thrombosis.

Anticardiolipin antibodies (ACLAs) are strongly associated with thrombosis and appear to be the most common of the acquired blood protein defects causing thrombosis. Although the precise mechanism(s) whereby ACLAs alter hemostasis to induce a hypercoagulable state remain unclear, several theories, as previously discussed, have been advanced. The most common thrombotic events associated with ACLAs are deep vein thrombosis and pulmonary embolus (type I syndrome), coronary or peripheral artery thrombosis (type II syndrome), or cerebrovascular/retinal vessel thrombosis (type III syndrome), and occasionally patients present with mixtures (type IV syndrome). The relative frequency of ACLAs in association with arterial and venous thrombosis strongly suggests that these should be looked for in any individual with unexplained thrombosis; all three idiotypes (IgG, IgA, and IgM) should be assessed. Also, the type of syndrome (I through IV) should be defined if possible, because this may dictate both type and duration of both immediate and long-term anticoagulant therapy.

Adult↗
PubMed2003

Rapid resolution of portal vein thrombosis and noncirrhotic portal hypertension following cyto-reductive therapy in a patient with chronic myeloid leukemia.

The case of a 65 year old woman referred for further evaluation of back pain and with abnormalities at ultrasound including increase in portal vein diameter and splenomegaly is presented. Other tests, including bone marrow biopsy and Doppler ultrasound, led to a diagnosis of portal vein thrombosis secondary to chronic myeloid leukemia. After prompt cytoreductive therapy with leukapheresis and hydroxyurea, resolution of portal vein thrombosis and portal hypertension was achieved within a in one-month period. An abnormal increase of cells in circulating blood may lead to portal vein thrombosis in patients with myeloproliferative disorders such as chronic myeloid leukemia. Chronic myeloid leukemia is an unusual cause of portal vein thrombosis and portal hypertension. Early administration of cytoreductive therapy may lead to the resolution of portal vein thrombosis. In this report, etiopathogenetic factors of portal vein thrombosis and the role of cytoreductive therapy in the dissolution of thrombosis are discussed.

Aged↗
PubMed2004

Asymptomatic process of hepatic artery thrombosis in a patient after orthotopic liver transplantation.

BACKGROUND: Hepatic artery thrombosis is one of the serious complications after liver transplantation. It will mostly cause a failure of the transplantation. This case of hepatic artery thrombosis showed a stable clinical course and minimal histological change, and now has been surviving for 4 years with normal liver function. We investigated the possible causes for asymptomatic hepatic artery thrombosis in one patient after orthotopic liver transplantation (OLT) and discussed the diagnosis of ischemia of OLT pathologically and clinically. METHODS: Liver function test, color Doppler ultrasonography, and hepatic arteriography were performed during the development of hepatic arteriothrombosis. Possible factors for the asymptomatic process of the thrombosis were analyzed. RESULTS: On the 4th postoperative day, thrombosis formed at the anastomotic stoma of the hepatic artery, and on the 11th postoperative day, the artery was completely occluded. Serial liver biopsies revealed intrahepatic cholestasis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium, and fibrosis in the portal area. Monitoring of liver function showed nothing abnormal except elevation of gamma-GT and ALP levels. On the 71st day after OLT, arteriography demonstrated that the hepatic artery remained completely occluded in addition to the establishment of collateral circulation and compensation of the portal vein. The patient didn't show any symptoms of arterial thrombosis. CONCLUSION: Collateral circulation and compensation of the portal vein are beneficial to allograft survival and avoidance of retransplantation after thrombosis of the hepatic artery. Color Doppler ultrasonography within 2 weeks after OLT is helpful to the early diagnosis of hepatic arteriothrombosis.

Adult↗
PubMed2004

Coronary stent thrombosis in bare metal stents.

OBJECTIVE: The incidence of coronary stent thrombosis has reduced with improved techniques and drugs. Nevertheless, clinical trials may not reflect real world practice due to the selective inclusion criteria, regional variations and more complex patients treated in day-to-day practice. We examined the frequency, predisposing factors and outcome of stent thrombosis in unselected patients undergoing bare metal stents. METHODS: All patients undergoing stent implantation are entered into a prospective database. We reviewed the incidence of stent thrombosis in our database for all patients with at least 6 months of follow up. RESULTS: From December 1996 through to December 2002, 1140 consecutive patients underwent a coronary stenting. Stent thrombosis occurred in 9 (0.8%) patients; 7 (78%) presented within 30 days of the procedure, while 2 had late stent thrombosis occurring after 30 days. The vessel was left anterior descending artery in all, 8 (89%) had a recent anterior myocardial infarction prior to the intervention and the mean stent length was 25 mm. CONCLUSION: The incidence of stent thrombosis is approximately 1% in the current era of intervention. Longer stent length in the left anterior descending artery following a recent myocardial infarction, seems to be associated with stent thrombosis.

Adult↗
PubMed2005

Polymorphism of the glycoprotein Ia and IIIa in the group of women in childbirth does not correlate with an increased risk of developing thrombosis.

OBJECTIVE: The aim of the study was to evaluate the prevalence of the GP Ia and GP IIIa polymorphisms in the group of women in labor, and to assess the risk of thrombosis associated with their occurrence. DESIGN AND SETTINGS: 245 women in labor hospitalized between 1.01.2001 and 31.12.2003 r. were enrolled in the study. Patients were qualified for the study if detailed physical exam and past medical history excluded existence of known risk factors predisposing to thrombosis. Study group was composed of 72 women in childbirth, which at some point during current pregnancy or in early labor were diagnosed with thrombosis, and control group included 173 women in labor randomly picked from the group of patients with uncomplicated pregnancies. Polymorphic regions of platelets glycoprotein were detected using genotyping methods based on polymerase chain reactions (PCR). RESULTS: 1.72% of patients were found to have thrombosis. The thrombosis was located in the venous system in 97.2% of cases. Arteries were affected in two patients (2.7%). Prevalence of individual platelets glycoprotein mutations did not differ between controls and study group. In both groups platelets glycoprotein polymorphisms moderately pro-thrombotic A1/A2 and C/T dominated, and the least numerous were strongly pro-thrombotic A2/A2 and T/T. CONCLUSIONS: Our results did not show the causative relationship between the existence of platelets GP IIIa/GP Ia mutations and venous system thrombosis in the women in labor. Probably presence of pro-thrombotic mutations of platelets glycoprotein in this group of patients does not represent the increased risk of thrombosis.

Adult↗
PubMed2005

[Acute or sub-acute thrombosis of steel stents].

The use of coronary endoprostheses has greatly contributed to the improvement in the results of coronary angioplasty. Nevertheless, the risk of stent thrombosis remains a major preoccupation. We studied a retrospective series of 2997 patients who had undergone coronary angioplasty between 1999 and 2003. 36 patients (1.2%) had an acute or sub-acute stent thrombosis, occurring in two thirds of cases in the first 4 days with particularly serious clinical consequences: 5 deaths (13.8%) and 27 myocardial infarctions (75%). A comparison between the 2 groups of patients with thrombosis (n = 36) and without thrombosis (n = 2961) using multivariate analysis determined predictive factors for thrombosis: systolic LV dysfunction < 40% (p < 0.0001 OR 3.8 [2-7.3]), angioplasty for lesions on the anterior interventricular artery (p < 0.0001 OR 2.7 [1.4-5]), angioplasty performed in the acute phase of MI (p < 0.05 OR 13.9 [6.7-29.2]), B2-type complex lesions (p < 0.01 OR 2.5 [1.3-5]), residual dissection at the dilated site (p < 0.02 OR 5.1 [1.4-18.2]). More than ever, acute thrombosis remains a topical subject. This study emphasises the incidence of steel stent thrombosis; the clinical consequences and the predictive factors for early occlusion.

Acute Disease↗
PubMedDate not supplied

Low-molecular-weight heparin and calcium heparin in thrombosis prophylaxis in patients with percutaneous arterial and venous ports for colorectal liver metastases.

STUDY OBJECTIVE: The evaluation of low-molecular-weight heparin use to prevent arterial and venous thrombosis in patients with indwelling arterial Port-a-Cath implants. METHODS: From 1996 to March 2003 we placed 370 indwelling hepatic arterial catheters with a minimally invasive approach. The left distal subclavian artery was approached from beneath the left clavicle, then an angiographic study of the tumoral vascular district was performed and the gastroduodenal artery was occluded by an embolus. A polyurethane catheter was introduced distally into the hepatic artery and connected to a reservoir through a 3-4 cm long subcutaneous tunnel. In 90 patients a venous Port-a-Cath was placed for concurrent systemic chemotherapy. All 370 patients received regional chemotherapy and were treated with calcium heparin at a dose of 5000 IU twice a day and with low-molecular-weight heparin at prophylactic doses (dalteparin 2500 IU or nadroparin 3000 IU) during catheter permanence to prevent hepatic artery thrombosis. Intra-arterial trans-port radionuclide scans using technetium-99m-labeled micro-aggregated albumin were performed monthly to check the infusion distribution and hepatic artery patency. In the presence of anomalous patterns, thrombosis, pulmonary embolism or other complications, angiography and/or other diagnostic studies were performed to determine the cause of the vascular event and the local or systemic symptoms. The mean arterial and venous Port-a-Cath permanence times were 6 and 8 months, respectively. RESULTS: We observed episodes of hepatic artery thrombosis in 4.3% of patients. Three of these 17 patients were successfully treated by intra-arterial thrombolysis using urokinase. No venous thrombosis occurred as a consequence of regional and/or systemic chemotherapy, no episodes of arterial thrombosis were registered during arterial catheter permanence, nor did any hemorrhagic complications related to anti-coagulant therapy occur. Five patients treated with low-molecular-weight heparin required treatment suspension due to a platelet count of < 40,000/dL. CONCLUSION: Our experience suggests that low-molecular-weight heparin and/or calcium heparin at prophylactic doses could be useful in the prevention of arterial and venous thrombosis in patients with indwelling arterial catheters or venous Port-a-Cath treated with regional or systemic chemotherapy for hepatic metastases from colorectal cancer. The homogeneity of the patient group and the use of analogous chemotherapeutic drugs (fluoropyrimidines) avoided statistical contamination related to differences between kinds of cancer and between the chemotherapeutic agents used.

Antineoplastic Agents↗
PubMed2006

Low fasting methionine concentration as a novel risk factor for recurrent venous thrombosis.

Hyperhomocysteinemia is a risk factor for venous thrombosis, but the underlying mechanism is unclear. If the thiol-group of homocysteine interferes with components of the clotting system, we expect that high cysteine will be also a risk factor for venous thrombosis. If high homocysteine reflects a disturbed methyl-group donation by S-adenosylmethionine, we expect that low methionine will be a risk factor for thrombosis. We performed a case-control study in 185 patients with recurrent venous thrombosis and in 500 control subjects. We determined methionine, homocysteine, cysteine and assessed the associated thrombotic risk. Low fasting methionine was associated with an increased risk on recurrent venous thrombosis [OR(bottom vs. top quartile) = 3.3 (95%CI 1.9-5.7)]. Low methionine remained a risk factor [OR(bottom vs. top quartile) = 3.5 (95%CI 2.0-6.0)] after adjusting for homocysteine and cysteine, whereas the thrombotic risk for homocysteine was lost [OR = 1.0 (95%CI 0.6-1.9)] after adjustment. Cysteine yielded a highest odds ratio of 2.1(top vs. bottom quartile) (95%CI 1.0-4.0) after adjustment. In conclusion, we found that low fasting methionine is a risk factor for recurrent venous thrombosis. This risk association was stronger for methionine than for homocysteine or cysteine. This supports the hypothesis that impaired methylation may be involved in the pathogenesis of venous thrombosis.

Adult↗
PubMed1991

[Real-time sonography in deep thrombosis of the pelvic and leg veins. A prospective comparison to phlebography].

Real-time B mode ultrasound is a well accepted diagnostic procedure in the non-invasive vascular examination. In a prospective study we examined 101 patients with clinical suspected deep vein thrombosis of the pelvis or leg using ultrasound and contrast venography within 24 hours and we compared the results of both examinations. All veins of the pelvis and lower extremities were scanned in transverse and longitudinal planes. 113 venograms were obtained; they demonstrated the presence of isolated proximal vein thrombosis in seven patients, seven isolated calf vein thromboses and 43 thromboses of both proximal and calf veins. The sensitivity of ultrasonography for detecting deep vein thrombosis in the proximal veins of the lower extremity was 98%, the specificity was also 98%. In the veins of the pelvis the sensitivity was 78%, the specificity 98% and in calf veins 60% and 97% respectively. The sensitivity for the detection of isolated calf vein thrombosis was only 14%. We conclude that ultrasonography has a very good sensitivity for detecting proximal vein thrombosis of the lower extremity and thrombosis of the pelvic veins. Phlebography remains the better method in detecting isolated calf vein thrombosis because of the difficult visualisation of the small calf veins by ultrasonography.

Adolescent↗
PubMed1989

[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy].

The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.

Adolescent↗
PubMed1988

Endothelial-dependent fibrinolysis in subjects with the lupus anticoagulant and thrombosis.

To investigate the hypothesis that diminished endothelial fibrinolytic activity contributes to the pathogenesis of thrombosis in patients with the lupus anticoagulant (LA), we assessed the ability of endothelium to release tissue-type plasminogen activator (t-PA) in response to standardized venous occlusion (VO) of the arm, and the extent of inhibition of t-PA, in 11 subjects with LA and a history of thrombosis and in 36 healthy normal subjects. The mean rise in plasma t-PA antigen after VO, the mean plasma free t-PA activity after VO, and the mean plasma t-PA inhibitor level prior to VO were not significantly different in subjects with LA and thrombosis and in normal subjects. Four subjects with LA and thrombosis (36%), and five of 36 healthy control subjects (14%) generated no detectable free t-PA activity after VO ("non-responders"); this difference was not statistically significant. All four "non-responders" with LA and thrombosis had normal t-PA antigen release after VO, indicating that the lack of detectable free t-PA activity after VO was due to increased inhibition of released t-PA. We conclude that abnormally reduced endothelial fibrinolytic activity is not present in the majority of subjects with LA and thrombosis. In the subset of subjects with LA and thrombosis who generate no detectable t-PA activity after VO, a stimulatory effect of LA on endothelial production of t-PA inhibitor cannot be excluded.

Adult↗
PubMed1988

Effect of drug administration on experimental renal glomerular thrombosis.

Experimental thrombosis which developed exclusively in glomerular capillary walls was induced in rats by the combined injection of nephrotoxic antiserum (0.2 ml of pooled material) as a preparatory agent and 20 micrograms or more of lipopolysaccharide as a provoking agent. Effects of some antiplatelet and anticoagulant drugs on the glomerular lesions were tested in this experimental glomerular thrombosis. With administration of 2000 units/kg or more of heparin at the time of provoking injection, coagulation time was prolonged for over 5 hr, and the glomerular thrombosis was adequately prevented. Prolongation of prothrombin time (PT) for over 60 sec to prevent thrombosis required warfarin, but with this drug there was only a narrow margin between an effective dose and that which produced a fatal hemorrhage. Low levels of fibrinogen (less than 50 mg/dl) induced by batroxobin seemed to protect partially and high doses of urokinase did not seem to protect from glomerular thrombosis. OP-41483, a derivative of prostacyclin which is about five times more active than PGE1 in inhibiting platelet aggregation, and other anti-platelet drugs except for ticlopidine were not effective in preventing glomerular thrombosis. These findings were in accordance with the fact that thrombocytopenia induced by antiplatelet antiserum did not prevent glomerular thrombosis. Ticlopidine may have a unique and valuable therapeutic potential for the control of this condition.

Animals↗
PubMed1987

Consequences of "conservative" conventional management of axillary vein thrombosis.

To evaluate the long-term effects of "conservative" management (heparin initially then Coumadin for 3 months) on patients with axillary vein thrombosis, the authors studied 20 patients (average age 44 years) who presented at the Wellesley Hospital in Toronto between 1975 and 1984. The diagnosis of axillary vein thrombosis was made from history, findings on physical examination and Doppler studies. In 12 patients, the diagnosis was confirmed by venography. Three patients subsequently underwent a first-rib resection for thoracic outlet syndrome. The average follow-up was 42 months. The cause of the thrombosis in 3 patients was an intravenous-line catheter, in 7 it was effort thrombosis and in 10 the cause was unknown. Two patients had had a previous deep venous thrombosis in the lower limb. Results of conservative treatment showed that only five patients had residual minimal swelling and two had minor discomfort. These symptoms did not interfere with either leisure or work activities in any of the patients. Fifteen patients were asymptomatic. One patient had nonfatal pulmonary embolism. The conservative management of axillary vein thrombosis is safe, effective, relatively inexpensive and gives excellent long-term results. The prognosis is good, irrespective of the cause of the thrombosis and, in view of this, a more aggressive approach, using either streptokinase therapy or thrombectomy, does not appear to be justified.

Adult↗
PubMed1994

Correlation of antiphospholipid antibodies and protein S deficiency with thrombosis in HIV-infected men.

Antiphospholipid antibodies (aPL) and free protein S (PSF) deficiency have been associated with clinical thrombosis. Previous reports described a high prevalence of these abnormalities in HIV-infected individuals, but suggested there was little associated clinical thrombosis. A cohort of 74 HIV-infected men were studied for aPL, PSF deficiency and the development of thrombosis. aPL, predominantly anticardiolipin antibodies (aCL), were detected in 86% and PSF deficiency in 33%. While 42% of men with aPL also had low PSF levels, there was no correlation between aCL titres or most measures of aPL and PSF levels. However, a strong correlation was noted between a subset of aPL that reacted to phosphatidylethanolamine by hexagonal array assay and low PSF levels. There was no significant correlation between aPL, PSF deficiency and clinical features (medication use, opportunistic infection, CD4 cell count) of HIV in 60 patients for whom clinical information was available. The overall incidence of thrombosis in this group was 18%, and thrombosis developed in 6.6% of those followed prospectively over a median follow-up of 12 months. Development of thrombosis was not significantly correlated with aPL or PSF deficiency, but the high prevalence of these abnormalities may necessitate larger study groups to determine the risk associated with these coagulation changes. Study of a larger group with careful analysis of subsets of aPL, especially those associated with low PSF levels, and longer clinical follow-up could identify the HIV-infected individuals at risk for thrombosis.

Adult↗