Activated protein C-resistance caused by factor V gene mutation: a common coagulation defect in chronic venous leg ulcers

Twenty-three patients with venous leg ulcers were studied, in addition to 23 normal healthy controls. Activated protein C resistance [APCR] was determined by functional assay based on the activated partial thromboplastin time [APTT]. Then, patients with an abnormally low APC ratio were subjected to molecular analysis for the confirmation of factor V Leiden. APC resistance was detected in nine of 23 patients. However, only five of nine patients were found to be heterozygous for factor V Leiden mutation. Factor V Leiden mutation was significantly more frequent in patients with chronic venous insufficiency and venous leg ulcers than in the control group. Patients with factor V Leiden mutation were more likely to have a history of venous thrombosis than the non-affected ones. The recurrent leg ulceration occurred more frequently in patients with factor V Leiden mutation than those without mutation

Variations in white blood count, thromboxane B2 levels and hematocrit in chronic venous hypertension

Objective: To analyze variations in leukocyte count and thromboxane B2 production in the femoral vein of patients with chronic venous hypertension (CVH). Design: Prospective clinical study, controlled, non randomized and open. Location: Hospital das Cl[inicas, Faculdade de Medicina da Universidade de Sao Paulo, referral center, university hospital. Participants: 15 patients with recurring stasis ulcer were analyzed, selected randomly from the venous diseases outpatient center, and 4 without lower limb venous alterations were also analyzed. Intervention: Blood samples from the femoral and brachial veins were drawn following supine and 45º reverse Trendelenburg. Main outcomes measures: Direct leukocyte count and analysis of the thomboxane B2 with enzyme linked immunosorbent assay test. Results: After 30 minutes in reverse Trendelenburg, patients with CVH showed a leukocyte count reduced by +27 per cent (p=0.02) and thromboxane B2 levels increased by +158 per cent (p=0.02). Conclusions: We suggest that future studies of medications for stasis ulcers include their effects on leukocyte entrapment and thromboxane B2 production in the lower limb venous system.