Kreidy Raghid, Salameh Pascale, Waked Mirna
Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon.
Vasc Health Risk Manag. 2012;8:161-7. doi: 10.2147/VHRM.S29457. Epub 2012 Mar 13.
Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients.
From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females) younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years). The control group included 217 patients (86 males and 131 females) older than 50 years (range: 50-96 years; mean 72.9 years).
The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001), pregnancy (18.2% compared with 0.5%; P < 0.001), treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001), and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084).
Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia represent a frequent cause of venous thrombosis among young female patients. Inferior vena cava abnormalities should be excluded in young patients with spontaneous proximal venous thrombosis especially when recurrent venous thrombosis or resistance to anticoagulation are observed.
年轻成人下肢深静脉血栓形成并不常见，且文献中对此研究不足。本研究旨在确定50岁以下患者深静脉血栓形成的危险因素，将其与对照组进行比较，并针对这一特定患者群体的静脉血栓管理和治疗提出建议。
回顾性分析2003年1月至2011年1月在一家学术性三级医疗中心通过彩色多普勒血流扫描诊断为下肢深静脉血栓形成的66例连续的黎巴嫩患者（29例男性和37例女性），年龄在21至50岁之间（平均38.7岁）。对照组包括217例年龄大于50岁（范围：50 - 96岁；平均72.9岁）的患者（86例男性和131例女性）。
年轻年龄组中最常报告的危险因素是遗传性血栓形成倾向（46.9%，对照组为13.8%；P < 0.001）、妊娠（18.2%，对照组为0.5%；P < 0.001）、雌激素药物治疗（13.6%，对照组为2.3%；P = 0.001）以及静脉血栓栓塞家族史（9.1%，对照组为3.8%；P = 0.084）。
遗传性血栓形成倾向是50岁以下患者中最常观察到的危险因素，其患病率是对照组的三倍多。即使存在短暂的获得性危险因素，也应对年轻成人进行血栓形成倾向筛查。妊娠和雌激素药物治疗，尤其是与遗传性血栓形成倾向相关时，是年轻女性患者静脉血栓形成的常见原因。对于自发性近端静脉血栓形成的年轻患者，尤其是观察到复发性静脉血栓形成或对抗凝治疗有抵抗时，应排除下腔静脉异常情况。
