不同年龄段患肺血栓栓塞症的危险因素及临床特征比较

目的探讨不同年龄段肺血栓栓塞症(PTE)临床特征的差异,提高对各年龄组人群PTE的认识。方法对广州医学院第一附属医院广州呼吸疾病研究所1997年8月至2006年4月确诊为急性PTE的105例患者(其中年龄≥60岁组57例,<60岁组48例)的临床资料进行回顾性分析,比较两年龄段PTE的危险因素及临床特征的差异。结果(1)危险因素:<60岁组PTE的发病危险因素较≥60岁组少。静脉炎在两组均是最常见的危险因素。<60岁组PTE患者常见的危险因素还包括静脉注射毒品、家族性易栓症等;而慢性阻塞性肺疾病(COPD)、长期制动、恶性肿瘤、心脏病等危险因素更常见于≥60岁组的PTE患者。(2)临床症状:胸痛和咯血在<60岁组中相对多见,三联征(即同时具有呼吸困难、胸痛和咯血症状)更常见于<60岁组;而晕厥则常发生于≥60岁组的PTE患者。≥60岁组更易发生大面积PTE。(3)实验室改变:<60岁组动脉血氧分压(PaO2)平均绝对值高于≥60岁组,PaO2相对百分比在两组间差异无显著性意义。两组肌钙蛋白阴性的PTE患者出现严重并发症几率明显低于肌钙蛋白阳性者。结论≥60岁的PTE患者危险因素多,临床表现可能不典型,且更易出现大面积PTE;<60岁的PTE患者临床症状可相对典型。心肌肌钙蛋白可作为PTE预后的评估指标。     

48例恶性肿瘤并发肺血栓栓塞症临床分析

目的:分析恶性肿瘤患者发生肺血栓栓塞症(PTE)的危险因素及临床特点,以增强医生诊断意识。方法:对2000年1月1日至2010年12月31日,北京安贞医院住院的48例恶性肿瘤合并PTE患者临床资料进行回顾性分析。结果:呼吸系统肿瘤患者16例(33.33%),消化系统肿瘤患者13例(27.08%),泌尿生殖系统肿瘤患者9例(18.75%),乳腺癌患者8例(16.67%),血液系统肿瘤患者1例(2.08%),甲状腺癌患者1例(2.08%)。男性常见肿瘤为肺癌,女性常见肿瘤为乳腺癌。患者中以手术、年龄≥60岁、静脉血栓栓塞病史、伴发肿瘤转移等为常见危险因素。18例(37.50%)为诊断恶性肿瘤前发现PTE,4例(8.33%)发生在围手术期,26例(54.17%)为确诊恶性肿瘤后发现PTE。PTE治疗后好转出院35例(72.92%),治疗无效1例(2.08%),死亡6例(12.50%)。结论:恶性肿瘤患者是发生血栓事件的高危人群,早期正确评价恶性肿瘤患者合并PTE风险,做好预防是改善预后的关键。     

肺血栓栓塞症-深静脉血栓形成的分子流行病学

肺血栓栓塞症 (pulmonarythromboembolism ,PTE)与深静脉血栓形成 (deepvenousthrombosis ,DVT )共属于静脉血栓栓塞症 (venousthromboembolism ,VTE)。已公认VTE是一种多基因疾病 ,抗凝、凝血、纤溶系统以及某些酶类相关基因的异常均可成为其遗传性危险因素 (表 1)。表 1　VTE的常见遗传性危险因素种类一般人群中的分布 VTE人群中的分布首发VTE的RRFactorⅤLeiden　0 .0 5% (非洲、亚洲 ) 4 .8%(高加索 )18.8%　6～ 8　APCR　3.6 %～ 6 %　2 1%10 %～ 6 4% 　 -　凝血酶原G2 0 2 10A　0 .0 6 % (非洲、亚洲 ) 2 .7%(高加索…     

脑卒中后偏瘫患者症状性下肢深静脉血栓形成的临床特点

目的探讨脑卒中后偏瘫患者并发症状性下肢深静脉血栓(deep venous thrombosis,DVT)形成的临床特点。方法回顾2006年1月-2011年12月收治的822例脑卒中患者,对其中35例脑卒中后偏瘫并下肢红肿疼痛经静脉造影和/或超声证实的DVT患者资料分析,并通过与同期收治的35例非DVT卒中患者进行血同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平对比,了解症状性DVT的发生率、发生时间及可能的危险因素。结果本院脑卒中后偏瘫患者症状性DVT的发病率为35/822(4.3%),DVT发生在瘫痪侧32例,其中同为左侧28例;脑卒中后发生症状性DVT的时间主要集中在住院2周～4周;肢体肌力0～Ⅱ级31例,Ⅲ级及以上者4例;年龄≥65岁28例;有股静脉置管史21例;合并高血压33例;有糖尿病19例;有心房纤颤者8例;合并高脂血症12例。脑卒中后DVT组血Hcy、CRP水平明显升高,与对照组相比有统计学意义。结论高龄、重度肢体瘫痪、高血压、糖尿病、房颤、高脂血症、股静脉置管、高同型半胱氨酸血症、炎症可能是脑卒中后偏瘫患者发生DVT的危险因素,为避免DVT的发生及其所产生的不良后果,临床上应对具有上述危险因素的脑卒中患者给予必要的预防。     

老年髋部骨折术前深静脉血栓发生率及危险因素分析

目的研究老年髋部骨折术前深静脉血栓(DVT)的发生率及其危险因素,从而促进DVT的预防。方法回顾性分析解放军总医院2008年3月至2012年10月收治的老年髋部骨折患者386例,根据术前双下肢静脉彩超结果分为DVT组和非DVT组,分析糖尿病、肿瘤、心血管病、呼吸疾病、肝病、肾病、风湿病及痴呆等危险因素。结果术前34例(8.8%)确诊为DVT,其中股静脉2例(5.88%),胭静脉4例(11.76%),胫后静脉l例(2.94%),单侧小腿肌间静脉20例(58.82%),双侧小腿肌间静脉5例(14.71%),腓静脉2例(5.88%)。术前因肺动脉栓塞死亡3例。BMI≥30.0 kg/m~2、风湿病史、合并≥3种内科疾病为术前DVT发生的独立危险因素(P0.05)。结论老年髋部骨折术前DVT发生率高,BMI≥30.0 kg/m~2、风湿病史及合并≥3种内科疾病的患者入院后应评估血栓风险,积极预防,以减少DVT的发生。     

交通伤所致肺栓塞患者临床特征分析

目的探讨交通伤所致肺动脉栓塞(PTE)的临床特征。方法选择我院经CT肺动脉造影(CTPA)确诊的交通伤所致PTE的病例71人,所有患者同时行下肢螺旋CT静脉造影(CTV)检查,收集患者临床资料,分析患者临床特征。结果入组的71例PTE患者中,DVT发生率100%,其中41例为双下肢DVT(57.7%);单一下肢DVT患者30例(42.3%)。发生交通伤至出现PTE症状的时间半个月～6个月。多在用力大便或开始功能练习过程中发生,主要表现为呼吸困难(59/71例,83.1%)、胸痛(46/71例,64.8%)、咯血(19/71例,26.8%)、晕厥(5/71例,7.0%)。呼吸困难、胸痛、咯血三联症者24例,占33.8%。29例(40.8%)同时并存糖尿病、支气管哮喘、高脂血症、高血压或者冠心病之一病史,4例(19.0%)女性有口服避孕药史。结论当交通伤患者出现呼吸困难、胸痛等症状,尤其是合并多个临床危险因素时,需要临床医师要高度重视交通伤患者可能并发肺栓塞。     

肺血栓栓塞症患者相关危险因素

目的分析肺血栓栓塞症(PTE)住院患者相关危险因素。方法回顾分析吉林大学白求恩第一医院2011年6月至2014年2月确诊的168例PTE患者的获得性和遗传性危险因素。所有患者在抗凝治疗前取外周血检测了蛋白C(PC)、蛋白S(PS)和抗凝血酶(AT-Ⅲ)活性。结果主要获得性危险因素近期外科手术或外伤(38.1%)、深静脉血栓形成(DVT)或PTE病史(14.3%)和下肢静脉曲张病史(14.3%)。抗凝蛋白总缺乏率为84.5%,PS缺乏最高(48.8%),其次是PC缺乏最低(24.4%)、AT-Ⅲ缺乏最低(11.3%)。结论研究显示住院PTE患者中,近期外科手术或外伤、DVT或PTE病史和下肢静脉曲张病史是主要的获得性危险因素,而在遗传性危险因素中以PS缺乏为主,其次是PC缺乏,AT-Ⅲ缺乏率最低。多种危险因素并存是促发PTE的重要原因。     

急性肺血栓栓塞症的发病特点及临床分析

目的 分析急性肺血栓栓塞症(PTE)的发病特点及临床特征,提高临床医师对急性PTE的认识,规范PTE的诊断和治疗.方法 2009年1月1日至2009年12月31日所有入住北京朝阳医院确诊的急性PTE患者,分析其流行病学、危险因素、临床症状、辅助检查、治疗以及临床转归情况.结果 1年内共确诊PTE 137例.住院患者PTE的发病率为0.37％,高于亚洲住院患者PTE的发病率.PTE在冬季多发,住院患者的发病率达0.52％.平均发病年龄(62.14±15.16)岁,60岁以上患者为62.77％.女性(60.58％)多于男性(39.41％).初诊科室分布广泛,以呼吸与危重症医学科为主要科室,为75.18％.危险因素以恶性肿瘤最高,其次为既往有静脉血栓病史.临床表现以呼吸困难为主,其次为胸闷和胸痛.血气分析表现为低氧和(或)低二氧化碳血症.心脏超声提示右心功能障碍者44例,血栓直接征象者5例.下肢静脉超声提示有67.20％的PTE患者合并下肢静脉血栓,以远端静脉多见(67.63％).溶栓抗凝治疗14例,单纯抗凝治疗122例.好转出院134例(97.08％),死亡2例(1.46％).结论 提高各临床科室医师对于急性PTE的诊断意识及治疗规范化程度,可以提高确诊率,降低病死率.急性PTE以恶性肿瘤以及静脉血栓栓塞症病史为主要危险因素.临床症状多样,以新发的呼吸困难最为常见.超声心动图及下肢静脉超声检查联合应用可作为疑诊PTE而无确诊手段时的替代诊断方法.     

肺癌合并肺血栓栓塞症和深静脉血栓形成的比较研究

目的比较肺癌合并肺血栓栓塞症(PTE)和深静脉血栓形成(DVT)的临床特点及预后。方法对2003年1月至2013年4月北京医院肺癌合并PTE和DVT的患者进行回顾性临床分析,记录年龄、性别、临床表现、病理类型、TNM分期、PS评分、化疗方案及预后等临床信息。结果 PTE组35例,年龄(67.31±9.38)岁,DVT组45例,年龄(64.62±12.48)岁。PTE组肺部基础疾病的发生率高于DVT组(9 vs 4例,P=0.043);而DVT组留置深静脉导管的患者显著多于DVT组(11 vs 1例,P=0.007)。PTE组HCT和Hb较DVT组增高(分别为36.9±4.01 vs 33.44±5.57,P=0.003;125.4±14.43 vs 113.48±21.28,P=0.006)。PTE组中有14例PTE患者为无意中发现。在两组病人中,以NSCLC为主,病理类型多为腺癌,TNM分期Ⅲ~Ⅳ期居多。肺癌合并PTE组3月、6月、9月和12个月累积发生率分别为71.4%、77.1%、82.9%和85.7%;DVT组3月、6月、9月和12个月累积发生率分别为75.6%、77.8%、82.2%和84.4%。生存分析显示,PET组和DVT组,中位生存时间无显著差异(5.0±2.1月vs 15.6±6.59月,P=0.12)。结论肺癌合并PTE和DVT患者具有相同的危险因素,但PTE组较多合并肺部疾病,而DVT组较多留置深静脉导管。两组患者中腺癌是最常见的病理类型,TNM分期多为Ⅲ~Ⅳ期。PTE或DVT多发于肺癌诊断3~6月内,并导致患者预后不佳。     

临床疑诊下肢深静脉血栓形成的超声诊断

深部静脉血栓形成 (DVT)是临床上常见的静脉疾病 ,作者对临床高度怀疑下肢 DVT病例所做的超声多指标检查 ,进行了归类统计 ,对比分析。1　对象和方法　对近 10年来临床疑诊有下肢 DVT,作超声检查的 45 9例患者 5 89条下肢静脉的超声特性进行分析 ,共检出有血栓者 2 19(男 119,女 10 0 )例 ,年龄 11～ 87(4 8±16 )岁 ,病变肢体共 2 44 (左下肢 15 9,右下肢 85 )条 ,无血栓者2 40 (男 113,女 12 7)例 ,年龄 4～ 82 (4 6± 16 )岁 ,病变肢体共34 5 (左下肢 188,右下肢 15 7)条。　　仪器 :HP- 10 0 0 / 15 0 0 / IP型彩超仪 ,选用 3.5 /…     

应用放射性核素显像对下肢深静脉病变和肺血栓栓塞症的临床观察

目的　探讨下肢深静脉血栓形成与肺动脉血栓栓塞症之间的关系。方法　病例选择为1997年 9月～ 2 0 0 1年 5月临床诊断高度怀疑肺动脉血栓栓塞症患者 140例 (男 79例 ,女 6 1例 ) ,平均年龄为 39± 18岁。所有患者均行肺灌注、肺通气显像及下肢深静脉显像。其中 2 6例患者同时进行肺动脉造影 ,11例行X线下肢静脉造影检查 ,36例行下肢血管超声检查 ,18例行下肢容积血流阻抗图检查。结果　 140例肺血栓栓塞患者中有下肢静脉病变者为 12 0例 ,占 85 7%。近端病变 113例(80 0 % )。下肢深静脉显像与X线下肢静脉造影、下肢容积阻抗图及下肢血管超声检查符合率分别为 90 9% ,72 2 % ,80 0 %。结论　研究证实下肢静脉病变和血栓形成是肺动脉血栓栓塞症的主要致病因素 ,栓子主要来源于近端静脉血栓。放射性核素肺灌注 /肺通气、下肢静脉显像是诊断肺血栓栓塞症和下肢深静脉病变的有效方法。     

Diagnostic value of the clinical probability score of deep venous thrombosis in the elderly

SUBJECT: There is a lack of scientific data concerning the incidence, clinical signs, risk factors and diagnostic management of deep vein thrombosis (DVT) in the elderly. METHODS: We carried out a prospective case-control study in a geriatric setting. We included one in-patient without clinical signs of deep vein thrombosis for each hospitalised patient with clinically suspected DVT. Clinical signs, risk factors of DVT and a compression ultrasonography of the proximal and distal leg veins were performed in all patients at admission. Also, the clinical probability was assessed by means of the clinical score model described by Wells. RESULTS: There were 102 patients aged over 85 included during the 5 months period of the study. Fifty-one patients have had a clinical suspicion of DVT and 51 patients were clinically asymptomatic. There were 43% symptomatic DVT and 12% asymptomatic DVT. Clinical signs and symptoms of DVT were neither sensitive nor specific. Risk factors associated most frequently with DVT were: immobilisation (prevalence 64%), paralysis of the legs (22%), varicose veins (25%), deshydratation (28,5%), infections (18%). A significant relationship between a risk factor and DVT was found only for immobilisation (P<0,05) and deshydratation (P<0,02). The prevalence of DVT increased with the clinical probability score: 11.4% for the low score, 27.6% for the moderate score and 55% for the high score. CONCLUSION: Incidence of DVT is high among hospitalised elderly patients, especially for the asymptomatic ones. Clinical signs alone do not reliably predict DVT. Clinical probability score could be useful to improve diagnostic management of DVT in this population.     

The incidence of venous thromboembolism following stroke and its risk factors in eastern China

Few studies have documented the prevalence of venous thromboembolism (VTE) in the Chinese population. We aimed to investigate the incidence of VTE following stroke and to determine the potential risk factors for the onset of VTE in patients of eastern China. A prospective multi-center study was conducted. A total of 1,380 patients with acute stroke received venous duplex ultrasound (VDU) examination on both lower limbs. The National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI), Wells, and modified Rankin scale scores were determined. Among 1,380 cases of acute stroke, 4.49 % (62 cases) had deep venous thrombosis (DVT) and 0.80 % (11 cases) had pulmonary thromboembolism (PTE). In the cases of DVT, 48.4 % had no clinical symptoms. The independent risk factors for the incidence of DVT, following the acute stage of stroke, were an age ≥ 70 years, bed-ridden, a Wells score ≥ 2, an NIHSS score of lower limbs ≥ 3, a low BI score, and an elevated concentration of D: -dimer. Rehabilitative and anti-coagulant therapy prevented the incidence of DVT following stroke. Moreover, an age ≥ 70 years, bed-ridden and having DVT were the independent risk factors for the incidence of PTE among stroke patients during the acute stage. Finally, 1.51 % of the patients had DVT whereas no PTE occurred during the period of the follow-up study. VDU examination is recommended for patients with acute stroke, which may help to diagnose and treat asymptomatic DVT early as well as prevent the subsequent incidence of PTE.     

静脉血栓栓塞症患者的临床特点和增龄性变化

[其它论文] -Congress J Thromb an Haemost2003

Venous thromboembolic disease comparison of the diagnostic process in men and women [其它论文] -Archives of Internal Medicine2003

Venous thromboembolism in the intensive care unit [其它论文] -Critical Care Clinics2003

Venous thromboembolism in pregnancy and the puerpcrium:incidence and additional risk factors from a London perinatal database [其它论文] -British Journal of Obstetrics and Gynaecology2001

Oral contraceptives and Venous thromboembolism:a five-year national case-control study [其它论文] -Contraception2002

重视肺血栓栓塞症合并冠心病的诊断和治疗 [其它论文] -中国心血管杂志2008

内科住院患者静脉血栓栓塞症预防的中国专家建议 [其它论文] -中华老年医学杂志2009

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Low accuracy of color Doppler ultrasound in the detection of proximal leg vein thrombosis in asymptomatic high-risk patients. The RD Heparin Arthroplasty Group.

OBJECTIVE: To evaluate the ability of color Doppler ultrasound to detect proximal deep venous thrombosis (DVT) in asymptomatic high-risk patients who subsequently underwent contrast venography. DESIGN: Prospective cohort study using blinded observers, with contrast venography as the comparison standard. SETTING: Seven medical centers (university and community hospitals) participating in a clinical trial of low-molecular-weight heparin for prevention of DVT. PATIENTS: A total of 385 consecutive patients undergoing elective unilateral hip or knee replacement. MEASUREMENTS: Ten days after surgery or before hospital discharge (whichever occurred first), patients had bilateral color Doppler ultrasound examinations of the proximal veins of the lower extremities. Subsequently, a contrast venogram of the operated leg was obtained. RESULTS: Color Doppler ultrasound studies and venograms were both evaluable in 319 of the 385 patients. Deep venous thrombosis was identified by contrast venography in 80 patients (prevalence, 25%; 95% CI, 20% to 30%) and involved the proximal veins in 21 patients (prevalence, 7%; CI, 4% to 10%). For proximal DVT, color Doppler ultrasound showed poor sensitivity (38%; CI, 18% to 62%), moderately good specificity (92%; CI, 89% to 95%), and a poor positive predictive value for this population (26%). CONCLUSION: Color Doppler ultrasound examinations are insensitive to proximal DVT in asymptomatic high-risk patients and should not be substituted for venography for identifying proximal DVT in such patients.     

Ambulatory care for ambulant patients with deep vein thrombosis

A follow-up study is reported on 49 patients with acute deep vein thrombosis (DVT) treated on an ambulatory basis. Venography had shown crural DVT in 27 % and proximal extension in 73 %. The initial treatment consisted of heparin (7,500 U iv, 40,000 U sc), ethylbiscoumacetate (900 mg), phenprocoumon (9 mg), and a ready made compression stocking for the calf. The patients were advised to undertake frequent strolls, the first when leaving the office. Pain, swelling and incapacity for walking vanished within two days. The partial thromboplastintime was prolonged 2.4-times on the first day and the thromboplastintime was in the therapeutic range on the second day already. Until follow-up 4 patients died of other diseases. There was no clinical pulmonary embolism, no secondary hospitalisation and only one new DVT. Of 844 months of patients at risk of recurrence 50 % passed under anticoagulants and 70 % with compression therapy. At an average of 19 months, 82 % of patients were asymptomatic and 45 % showed mild chronic venous insufficiency. In contrast, impaired drainage function (by lightreflectionrheography) was found in 79 % overall and in 100 % after DVT of the proximal veins. The discrepancy is explained by the compliance with compression therapy.     

深静脉血栓形成103例临床分析

目的 提高对深静脉血栓形成（ＤＶＴ）和肺栓塞（ＰＥ）的认识,了解二者的关系。方法 对１０４３例ＤＶＴ病例做一回顾性分析。结果 ＤＶＴ与ＰＥ关系密切,ＤＶＴ病例中ＰＥ的发生率为４４．７％。有危险因素者占８８．３％,最常见的危险因素为长期卧床（２ ６．２％）     

124例肺血栓栓塞症的临床分析

目的 对本院1998～2006年189例肺血栓栓塞症(pulmonary thromboembolism,PTE)患者中资料完整的124例进行临床回顾性分析.方法 发诊断标准符合中华医学会呼吸病学会制定的诊断标准,对所有124例PTE患者的病史、临床表现、心电图、X线胸片、血气、下肢深静脉超声、彩色多普勒心脏超声、螺旋CT肺血管造影(CTPA)、肺通气/灌注扫描(V/Q显像)等临床资料进行分析.结果 PTE-DVT年发病数逐年增加.大面积PTE 83例(66.9%),次大面积PTE 20例(16.1%),非大面积PTE 21例(16.9%).DVT 70例,术后40例,长期卧床65例,恶性肿瘤6例,结缔组织病3例,睡眠呼吸暂停低通气综合症1例.所有患者均有不同程度的呼吸困难,心悸90例,胸痛30例,咯血19例.咳嗽40例,晕厥16例,突然心跳、呼吸停止机械通气5例.呼吸频率>20次/min 86例,心率>100次/min 112例,发绀65例,肺部闻及干湿哕音22例.PaO<,2><60 mm Hg 72例,PaCO<,2><35 mm Hg 92例,PaCO<,2> >35 mm Hg 32例;心电图窦速112例,S<,Ⅰ> Q<,Ⅲ>T<,Ⅲ>型改变者25例,CRBBB型改变26例,非特异性S-T改变42例,窦性心动过缓5例;胸部X线检查有阴影者20例,行CTPA检查105例,V/Q显像18例,肺动脉造影1例;心脏超声显示右心室扩张合并肺动脉高压共91例,20例仅有肺动脉高压,无右心室扩大,8例心脏超声完全正常.首诊24 h内确诊72例,其余52例确诊时间为2～60 d,误诊率为30%(37例),其中误诊为冠心病、急性左心衰、肺炎者最多.溶栓抗凝治疗83例,单纯抗凝治疗41例,死亡8例(6.5%).结论 经 PTE的发病呈逐年增高的趋势;特别要注意恶化肿瘤和结缔组织病是重要的易感因素;PTE最常见的症状是呼吸困难.因此,提高临床医生的诊断意识,以减少漏诊和误诊.     

70岁以上老年人肺血栓栓塞的临床特点分析

目的 探讨70岁以上老年人肺血栓栓塞(简称肺栓塞)的临床特点及溶栓、抗凝治疗的疗效。方法 回顾性分析了58例70岁以上老年肺血栓栓塞患者的临床表现、诊断方法及溶栓、抗凝治疗的疗效。结果 本组老年人因下肢深静脉血栓(DVT)形成致肺栓塞者43例占(74．1％)；因制动或长期卧床致肺栓塞28例占(48．2％)。以原因不明、程度不等的呼吸困难伴突发、持续性低氧血症为主要临床特征。螺旋CT肺动脉造影(CTPA)和肺通气／灌注扫描(V／Q)检出阳性率分别为95．7％(45／47)和62．5％(20／32)；误诊率为46．5％；溶栓 抗凝、抗凝、抗血小板凝聚治疗有效率分别为91．3％(21／23)、75．8％(22／29)和0(0／6)；治愈率分别为47．8％(11／23)、17．2％(5／29)和0(0／6)。结论 70岁以上老年人肺栓塞最常见危险因素为下肢深静脉血栓形成，其次为长时间的制动或卧床；临床表现复杂多样、不典型；CTPA对老年人肺栓塞诊断更具有可靠性和准确性；溶栓和抗凝治疗安全、有效，抗血小板凝聚治疗无效果，易再发。     

Prevalence of factor V Leiden and prothrombin 20210 A variant in Bulgarian patients with pulmonary thromboembolism and deep venous thrombosis.

Factor V Leiden mutation and prothrombin variant 20210 A are well-known risk factors for venous thrombosis (DVT). Recent papers have reported a lower prevalence of factor V Leiden in patients with pulmonary thromboembolism (PTE) than in patients with deep venous thrombosis. The aim of the present study was to compare the prevalence of factor V Leiden and the prothrombin 20210 G <-- A mutation in patients with DVT and in patients with PTE. We studied 128 consecutive patients (45 with DVT, 40 with PTE, and 43 with DVT and PTE) for factor V Leiden and prothrombin 20210 A. One hundred healthy persons matched by age and sex were used as controls. Factor V Leiden was present in five of the patients with PTE [12.5%; 95% confidence interval (CI), 1.5-23.5%; not significant], 15 of the patients with DVT (33.3%; 95% CI, 9.6-38.7%; P < 0.001), and 12 of the patients with DVT and PTE (27.9%; 95% CI, 4.8-33%; P = 0.001). Results for the prothrombin 20210 A mutation were as follows: four of 40 patients with PTE (10%; 95% CI, 0-13.3%; P = 0.46), nine of 45 (20%) of the patients with DVT (95% CI, 0.5-25.5%; P < 0.05) and eight of 43 with DVT and PTE were heterozygous (18.6%; 95% CI, 0-23.9%; P = 0.02). In conclusion, there is a significantly higher frequency of factor V Leiden among patients with DVT than in patients with PTE. However, there is no significant difference of factor V Leiden or 20210 A prothrombin mutation in patients with DVT than in patients with combined DVT/PTE, therefore patients with DVT, carriers of the mutations, do not appear to be at lower risk for pulmonary embolism.