Is there a Role for Thrombophilia Studies in Patients with Mesenteric Ischemia?

DOLORES PUENTE; HECTOR SOLAR MUNIZ; ANDREA ROSSI ; MARCELA MIODOSKY; CECILIA COLORIO; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

A history of mesenteric ischemia (MI) is observed amongpatients(pts) referred to intestinal transplantation. Thrombophilia hasbeen proposed as a cause, and identifying these disorders may determinethe management strategy.Aim: To describe the history, recurrence of thrombosis and the frequencyof prothrombotic conditions in pts with MI submitted for evaluationat our intestinal failure and transplant unit, between april 2006and june 2014.Materials and Methods: We retrospectively reviewed 25 pts (20 ofthem could be evaluated) with short and ultra short bowel syndromedue to MI.Results: 11/20 (55%) were men; median age 57.4 years (Range 25-78) all were diagnosed of MI treated with bowel resection. 13/20 presentedas an acute MI; 7 pts (35%) had previous symptoms ofchronic mesenteric ischemia. 25% presented the mesenteric thrombosisimmediately after an abdominal surgery; 2/20 had a previousepisode of thrombosis (recurrent pulmonary embolism and myocardialinfarction); 9 pts (45%) developed a new event after evaluation(4 arterial and 9 venous thrombosis). Although in 6/9 cases, recurrencewas reported associated to a catheter placement, only 2 ptshad this isolated localization and 7/9 episodes also included abdominaland cerebral vascular territories. Thrombophilia studies were performedin 10/20pts; the tests included both acquired and inheriteddisorders: antiphospholipid antibodies (APL); hyperhomocysteinemia(HHC); antithrombin, protein S and C deficiency; Factor V Leidenand Prothrombin AG 20210. Only 2 pts carried a pro thrombotic disorder,both were positive for APL and one of them also presented aprotein S deficiency and high levels of homocysteinemia. Three ptshad cancer as a predisposing factor, (2 pulmonary adenocarcinomaand 1 intrapelvic tumor). No underlying JAK2 + disorder could befound among these pts. One female had a history of oral contraceptiveintake as the unique factor previous to MI, and the history ofceliac disease was reported in another pt.Conclusion: Although published reports, prothrombotic disorderswere not a frequent finding among this cohort of MI pts referred toour unit. Thrombotic recurrence was a common complication regardlessthe thrombophilia screen. The role of these laboratory testsshould be re-evaluated.References:1. Transplantation Proceedings,46,2133-2135(2014)2. Mayo Clinic Proceedings, march 2013. 88 (3): 285-294