Is Abnormal Coagulation or Defective Fibrinolysis of Aetiological Importance in the Development of Deep Venous Thrombosis?

The present investigation was performed to study the aetiological importance of abnormal coagulation or defective fibrinolysis in the development of deep venous thrombosis (DVT). Sixty-nine patients with acute iliofemoral venous thrombosis were subjected to evaluation of coagulation and fibrinolytic parameters. Defective fibrinolysis, usually with an increased activity of the rapid tissue plasminogen inhibitor, was detected in 31 patients (45%), and increased factor VIII with normal fibrinogen was recorded in 10 patients (14%). Two patients had a hereditary deficiency of plasminogen and protein C, respectively, and a lupus anticoagulant was demonstrated in another patient. Antithrombin III deficiency was not detected in any patient. Abnormal findings were most frequently recorded in patients with ‘idiopathic’ DVT. Although the exact relationship between the development of DVT and the recorded abnormalities could not be determined in all instances, it is obvious that defective vessel wall fibrinolysis and increased factor VIII are frequently recorded in patients with extensive DVT of the lower limb. Pathological alternations of antithrombin III, plasminogen and protein C seem to be less common.