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An Elevated Homocysteine is More Common in Women than Men with Vascular Disease
Charudatta C. Bavare, MD, MPH1, Wissam Fawaz, BS2, Sarah Dakhlallah, BS2, Street Tiffany, NP1, Jean Bismuth, MD3, Eric K. Peden, MD1, Mark G. Davies, MD, PhD, MBA1, Alan B. Lumsden, MD4, Joseph J. Naoum, MD5.
1The Methodist Hospital and DeBakey Heart & Vascular Center, Houston, TX, USA, 2Lebanese American University and University Medical Center Rizk Hospital, Beirut, Lebanon, 3The Methodist Hospital and DeBakey Heart and Vascular Center, Houston, TX, USA, 4The Methodist Hospital and Debakey Heart & Vascular Center, Houston, TX, USA, 5The Methodist Hospital, Lebanese American University and University Medical Center Rizk Hospital, Houston, TX, USA.
OBJECTIVES: Hypercoagulable disorders can lead to deep vein thrombosis (DVT), arterial thrombosis or embolization, and early or recurrent bypass graft failure. The purpose of this study is to identify whether gender difference increases the likelihood of hypercoagulable disorders in patients with vascular disease.
METHODS: We reviewed clinical data on 300 consecutive patients. A hypercoagulable workup was performed if patients presented with (1) early bypass /graft thrombosis (<30 days), (2) multiple bypass / graft thrombosis, (3) a history of DVT, Pulmonary embolus (PE) or native vessel thrombosis. Relevant clinical variables were analyzed and compared for both women and men.
RESULTS: 85 patients (47 women; age 53 ± 16 years, range 16 - 82 years) had one of the defined conditions and underwent a hypercoagulable evaluation. Screening was done in 4.7% of patients for early bypass graft thrombosis, 60% of patients were screened because of multiple bypass or graft thrombosis, and 35.3% had a previous history of DVT, PE or native vessel thrombosis. Of the 47 women and 38 men evaluated, 62 patients (73%) had an abnormal hypercoagulable profile. An elevated homocysteine level was present in 43% of women and 32% of men (chi-squared test p<0.02), lupus anticoagulant was present in 32% and 37%, heparin antibodies in 17% and 26%, functional protein S deficiency in 26% and 13%, antithrombin III deficiency in 17% and 13%, functional protein C deficiency in 9% and 13%, anticardiolipin antibodies in 9 % and 8%, and Factor V Leiden mutation in 2%, respectively.
CONCLUSIONS:
Thrombosis of vascular conduits or native vessels remains a challenging problem affecting the vascular patient. The elevation of homocysteine levels in women needs further evaluation within the context of vascular disease.
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