Recurrent Unprovoked Venous Thromboembolism in a Young Female Patient with High Levels of Homocysteine

Ashish Anil Sule; Tay Jam Chin; Lee Hwei Khien

doi:10.1055/s-0032-1315626

International Journal of Angiology, Table of Contents

Int J Angiol 2012; 21(02): 095-098
DOI: 10.1055/s-0032-1315626

Case Report

Recurrent Unprovoked Venous Thromboembolism in a Young Female Patient with High Levels of Homocysteine

Ashish Anil Sule

¹Department of General Medicine, Subspecialty of Vascular Medicine and Hypertension, Tan Tock Seng Hospital, Singapore

,

Tay Jam Chin

¹Department of General Medicine, Subspecialty of Vascular Medicine and Hypertension, Tan Tock Seng Hospital, Singapore

,

Lee Hwei Khien

²Department of Pharmacy, Tan Tock Seng Hospital, Singapore

› Author Affiliations

Abstract

Hyperhomocysteinemia is a rare condition which predisposes to atherothrombosis. Recurrent venous thromboembolism (VTE) with hyperhomocysteinemia is known but extremely uncommon. Homocysteine levels of more than 22 umol/L can predispose to VTE in a middle-aged women. We describe a case of a middle-aged woman, community ambulant with recurrent VTE with intermediately high homocysteine levels. She had no other risk factors for recurrent venous thrombosis. In our article, we also discuss hyperhomocysteinemia and its link to VTE.

Keywords

antifactor Xa - cardiovascular risk factors - deep vein thrombosis - factor V Leiden - hypertension - thrombophilia

Full Text

References

References
1 Varga EA, Sturm AC, Misita CP, Moll S. Cardiology patient pages. Homocysteine and MTHFR mutations: relation to thrombosis and coronary artery disease. Circulation 2005; 111 (19) e289-e293
2 Lonn E, Yusuf S, Arnold MJ. Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators. et al Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006; 354 (15) 1567-1577
3 Boushey CJ, Beresford SAA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA 1995; 274 (13) 1049-1057
4 Kang SS, Wong PW, Malinow MR. Hyperhomocyst(e)inemia as a risk factor for occlusive vascular disease. Annu Rev Nutr 1992; 12: 279-298
5 Welch GN, Loscalzo J. Homocysteine and atherothrombosis. N Engl J Med 1998; 338 (15) 1042-1050
6 Mudd SH, Levy HL, Skovby F, Disorders of transsulfuration In: Scriver CR, Beaudet AL, Sly WS, Valle D. eds. The Metabolic and Molecular Bases of Inherited Disease. 7th ed. New York: McGraw-Hill; 1995: 1279-1327
7 Carey MC, Donovan DE, FitzGerald O, McAuley FD. Homocystinuria. I. A clinical and pathological study of nine subjects in six families. Am J Med 1968; 45 (01) 7-25
8 Malinow MR, Kang SS, Taylor LM. et al. Prevalence of hyperhomocyst(e)inemia in patients with peripheral arterial occlusive disease. Circulation 1989; 79 (06) 1180-1188
9 Coull BM, Malinow MR, Beamer N, Sexton G, Nordt F, de Garmo P. Elevated plasma homocyst(e)ine concentration as a possible independent risk factor for stroke. Stroke 1990; 21 (04) 572-576
10 Malinow MR, Sexton G, Averbuch M, Grossman M, Wilson O, Upson B. Homocyst(e)ine in daily practice: levels in coronary heart disease. Coron Artery Dis 1990; 1: 4-12
11 Mudd SH, Uhlendorf BW, Freeman JM, Finkelstein JD, Shih VE. Homocystinuria associated with decreased methylenetetrahydrofolate reductase activity. Biochem Biophys Res Commun 1972; 46 (02) 905-912
12 Erbe RW, Inborn errors of folate metabolism In: Blakely RL, Whitehead VM. eds. Folate and Pterins: Nutritional, Pharmacological, and Physiological Aspects. New York: Marcel Dekker; 1986: 413-425
13 D'Angelo A, Selhub J. Homocysteine and thrombotic disease. Blood 1997; 90 (01) 1-11
14 Wilcken DE, Gupta VJ. Sulphr containing amino acids in chronic renal failure with particular reference to homocystine and cysteine-homocysteine mixed disulphide. Eur J Clin Invest 1979; 9 (04) 301-307
15 Chauveau P, Chadefaux B, Coudé M. et al. Hyperhomocysteinemia, a risk factor for atherosclerosis in chronic uremic patients. Kidney Int Suppl 1993; 41: S72-S77
16 Ueland PM, Refsum H. Plasma homocysteine, a risk factor for vascular disease: plasma levels in health, disease, and drug therapy. J Lab Clin Med 1989; 114 (05) 473-501
17 Mayer EL, Jacobsen DW, Robinson K. Homocysteine and coronary atherosclerosis. J Am Coll Cardiol 1996; 27 (03) 517-527
18 Refsum H, Wesenberg F, Ueland PM. Plasma homocysteine in children with acute lymphoblastic leukemia: changes during a chemotherapeutic regimen including methotrexate. Cancer Res 1991; 51 (03) 828-835
19 Ueland PM, Refsum H, Brattstrom L, Plasma homocysteine and cardiovascular disease In: Francis Jr RB. ed. Atherosclerotic Cardiovascular Disease, Hemostasis, and Endothelial Function. New York: Marcel Dekker; 1992: 183-236
20 Ubbink JB, van der Merwe A, Delport R. , et al. The effect of a subnormal vitamin B-6 status on homocysteine metabolism. J Clin Invest 1996; 98 (01) 177-184
21 McCully KS. Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis. Am J Pathol 1969; 56 (01) 111-128
22 Arruda VR, von Zuben PM, Chiaparini LC, Annichino-Bizzacchi JM, Costa FF. The mutation Ala677—> Val in the methylene tetrahydrofolate reductase gene: a risk factor for arterial disease and venous thrombosis. Thromb Haemost 1997; 77 (05) 818-821
23 Ma J, Stampfer MJ, Hennekens CH. , et al. Methylenetetrahydrofolate reductase polymorphism, plasma folate, homocysteine, and risk of myocardial infarction in US physicians. Circulation 1996; 94 (10) 2410-2416
24 van Bockxmeer FM, Mamotte CD, Vasikaran SD, Taylor RR. Methylenetetrahydrofolate reductase gene and coronary artery disease. Circulation 1997; 95 (01) 21-23
25 den Heijer M, Koster T, Blom HJ. , et al. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. N Engl J Med 1996; 334 (12) 759-762