Brief report
Increased incidence of hypercoagulability in patients with leg ulcers caused by leukocytoclastic vasculitis

https://doi.org/10.1016/S0190-9622(03)00881-8Get rights and content

Abstract

Vasculitis is a rare cause of leg ulceration. It is unclear why severe skin infarction develops in some patients with vasculitis, whereas others have only mild symptoms such as purpura, erythema, or urticaria. A coincidence of vasculitis and hypercoagulability may lead to more extensive thrombotic occlusion and hence explain the occurrence of large ulcers in a subset of patients. Our aim was to investigate whether patients with vasculitis ulcers have an increased incidence of hypercoagulability. Thirteen consecutive patients admitted to the hospital with necrotic ulcers caused by histologically confirmed vasculitis were screened for clotting disorders. In 7 of 13 patients (53%), hypercoagulable conditions were found. Five patients had factor V Leiden (38%), and 2 had lupus anticoagulant (15%). The normal frequency of these conditions is 5% to 6% and 3.6%, respectively. These data indicate that there is an increased incidence of hypercoagulable disorders in patients with vasculitis ulcers. We recommend screening these patients routinely for hypercoagulability.

Section snippets

Patients and methods

Since 1999, all new consecutive patients that were admitted to the hospital (Department of Dermatology, Academic Medical Center, Amsterdam) for skin ulcers caused by vasculitis were included in the study. In all patients, the diagnosis “vasculitis ulcer” was already suspected at the moment of hospital admission because of clinical signs suggestive for vasculitis (usually multiple ulcerations, presence of black necrotic tissue, irregular borders, purple discoloration at the margins (Fig 1), or

Results

In total, 13 consecutive patients (all white, 5 male, 8 female, mean age 63 years) were included in the study. Most of them (85%) had multiple ulcers (mean: 5.3 ulcers). The average total wound size was 75 cm2, the average duration of the ulcers at time of admittance was 5.6 months, and the average duration from first onset to total healing was 8.5 months.

Discussion

Hypercoagulable disorders were found in 7 of 13 (53%) patients with leg ulcers caused by leukocytoclastic vasculitis. Five of them had factor V Leiden (38%). The normal frequency of factor V Leiden in the European population is estimated to be 5% to 6%.12

We hypothesize that the following sequence of events is taking place. In vasculitis, the vascular wall is damaged. The vascular damage initiates the coagulation cascade, prothrombin is converted to thrombin, and thrombin activates factor V and

References (21)

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Funding sources: None.

Conflict of interest: None identified.

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