vitamin-b-12 and Venous-Thrombosis

Cerebral venous thrombosis (CVT) is a rare disease, occurring in 0.5%-1% of all patients with strokes. Systemic and hereditary diseases and traumas are potential causes of CVT. We report a case of CVT and systemic thromboembolism complicated with hyperhomocysteinemia and iron-deficiency anemia caused by autoimmune gastritis. A 47-year-old female patient was admitted to the emergency department due to difficulty in movement, impaired consciousness, and urinary incontinence. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed bilateral thalamic edema associated with venous sinus thrombosis and embolic cerebral infarction in the deep white matter of the bilateral cerebral hemispheres. In addition, contrast enhanced whole-trunk CT scan showed deep femoral thrombosis and pulmonary artery embolism. She had no medical history of diseases or drug use that may cause thrombosis. Blood test results revealed iron-deficiency anemia and hyperhomocysteinemia, which were determined to be the cause of systemic thromboembolism. The patient tested positive for intrinsic factor antibodies. Moreover, the patient was diagnosed with autoimmune gastritis by gastrointestinal endoscopy. Therapies including anticoagulant and replacement with iron and vitamin B12 were administered. The patient was discharged from the hospital without neurological deficits. A favorable clinical course was achieved with anticoagulant administration and replacement therapy with iron and vitamin B12 for cerebral arteriovenous embolism that developed due to autoimmune gastritis.

Topics: Anemia, Iron-Deficiency; Anticoagulants; Embolism; Female; Gastritis; Humans; Hyperhomocysteinemia; Intracranial Thrombosis; Iron; Middle Aged; Thromboembolism; Venous Thrombosis; Vitamin B 12

People with end-stage kidney disease (ESKD) have high rates of cardiovascular events. Randomised controlled trials (RCTs) of homocysteine-lowering therapies have not shown reductions in cardiovascular event rates in the general population. However, people with kidney disease have higher levels of homocysteine and may have different mechanisms of cardiovascular disease. We performed a systematic review of the effect of homocysteine-lowering therapies in people with ESKD.. To evaluate the benefits and harms of established homocysteine lowering therapy (folic acid, vitamin B6, vitamin B12) on all-cause mortality and cardiovascular event rates in patients with ESKD.. We searched Cochrane Kidney and Transplant's Specialised Register to 25 January 2016 through contact with the Information Specialist using search terms relevant to this review.. Studies conducted in people with ESKD that reported at least 100 patient-years of follow-up and assessed the effect of therapies that are known to have homocysteine-lowering properties were included.. Two authors independently extracted data using a standardised form. The primary outcome was cardiovascular mortality. Secondary outcomes included all-cause mortality, incident cardiovascular disease (fatal and nonfatal myocardial infarction and coronary revascularisation), cerebrovascular disease (stroke and cerebrovascular revascularisation), peripheral vascular disease (lower limb amputation), venous thromboembolic disease (deep vein thrombosis and pulmonary embolism), thrombosis of dialysis access, and adverse events. The effects of homocysteine-lowering therapies on outcomes were assessed with meta-analyses using random-effects models. Prespecified subgroup and sensitivity analyses were conducted.. We included six studies that reported data on 2452 participants with ESKD. Interventions investigated were folic acid with or without other vitamins (vitamin B6, vitamin B12). Participants' mean age was 48 to 65 years, and proportions of male participants ranged from 50% to 98%.Homocysteine-lowering therapy probably leads to little or no effect on cardiovascular mortality (4 studies, 1186 participants: RR 0.93, 95% CI 0.70 to 1.22). There was no evidence of heterogeneity among the included studies (I² = 0%). Homocysteine-lowering therapy had little or no effect on all-cause mortality or any other of this review's secondary outcomes. All prespecified subgroup and sensitivity analyses demonstrated little or no difference. Reported adverse events were mild and there was no increase in the incidence of adverse events from homocysteine-lowering therapies (3 studies, 1248 participants: RR 1.12, 95% CI 0.51 to 2.47; I(2) = 0%). Overall, studies were assessed as being at low risk of bias and there was no evidence of publication bias.. Homocysteine-lowering therapies were not found to reduce mortality (cardiovascular and all-cause) or cardiovascular events among people with ESKD.

Topics: Aged; Cardiovascular Diseases; Cause of Death; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Kidney Failure, Chronic; Male; Middle Aged; Myocardial Infarction; Renal Dialysis; Stroke; Venous Thrombosis; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Venous thrombosis is considered as a multicausal disease. Hyperhomocysteinemia is considered as one of the risk factors for venous thrombosis. Because homocysteine levels are strongly influenced by the intake and concentrations of B vitamins, it is worthwhile to assess the role of these vitamins as a risk factor for venous thrombosis.

Topics: Homocysteine; Humans; Hyperhomocysteinemia; Risk Factors; Thromboembolism; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B 6; Vitamin B 6 Deficiency; Vitamin B Deficiency

Topics: Administration, Oral; Anticoagulants; Blood Coagulation Tests; Cardiovascular Diseases; Double-Blind Method; Drug Therapy, Combination; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Marfan Syndrome; Multicenter Studies as Topic; Mutation; Polymorphism, Genetic; Randomized Controlled Trials as Topic; Risk Factors; Thrombophilia; Time Factors; Venous Thrombosis; Vitamin B 12; Vitamin B 6

In recent years research was done to elucidate the relation between an increased homocysteine concentration and arterial as well as venous thrombosis. Several case control studies showed that an elevated homocysteine concentration is an independent risk factor for primary and secondary venous thromboembolism. It is not clear whether lowering homocysteine levels by administration of folic acid, whether or not in combination with vitamin B12 and vitamin B6, decreases the risk of vascular events. Randomized secondary prevention trials are being conducted at this moment. It is recommended to await the results of these trials before screening for and treating of individuals with hyperhomocysteinaemia.

Topics: Adult; Aged; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Prospective Studies; Pyridoxine; Randomized Controlled Trials as Topic; Venous Thrombosis; Vitamin B 12

To investigate the effects of folic acid combined with vitamin B12 on deep vein thrombosis (DVT) in patients with homocysteine cerebral infarction.. 90 patients with homocysteine cerebral infarction with DVT that were admitted to our hospital from January to July 2015 were selected as study subjects. They were divided into 2 groups randomly, the treatment group (n=45) and the non-treatment group (n=45). The treatment group was administered folic acid and vitamin B12, while the non-treatment group wasn't administered folic acid and vitamin B12. We compared and analyzed the levels of Hcy, folic acid and vitamin B12 of both groups. We investigated the correlation between the groups of patients with Hcy and folic acid and vitamin B12 treatment. We performed a comparative analysis of both groups of patients with an anticoagulant international normalized ratio (INR). The INR was recorded in detail for the first time as standard time, stable value time, obtain stable INR value time, activated partial thromboplastin time (APTT) and Prothrombin Time (PT) by color Doppler ultrasound observation of both groups with recurrent thrombosis.. We compared results of the intervention and treatment groups, and the prognosis of Hcy decreased significantly (p<0.05). While in the treatment group, folic acid and vitamin B12 levels increased significantly (p<0.05), the non-treatment difference of Hcy, folic acid, and vitamin B12 levels, before and after the patients in the intervention group, were not statistically significant (p>0.05). In the treatment group, Hcy was negatively correlated with folic acid (r=-0.376, p<0.05) while the Hcy of the treatment group was negatively correlated with vitamin B12 (r=-0.583, p<0.05). The intervention treatment group INR first standard time, stable value time and stable INR values were higher than those of non-treatment group (p<0.05). The treatment group APTT average was lower than in the non-treatment group (p<0.05). The average Pt in the treatment group was lower than non-treatment group (p<0.05). In the treatment group, lower limb deep static vein thrombosis recurrence rate was 4.4%, which was lower than the non-treatment group where the lower limb deep vein thrombosis recurrence rate was 28.9% (p<0.05).. Hcy is negatively correlated to folic acid and vitamin B12. Folic acid and vitamin B12 can reduce the recurrence rate of thrombosis in patients with lower extremity deep venous thrombosis in patients with Hcy disease. The mechanism of action may be to prevent the recurrence of thrombosis by reducing the levels of Hcy.

Topics: Adult; Aged; Cerebral Infarction; Drug Therapy, Combination; Female; Folic Acid; Homocysteine; Humans; International Normalized Ratio; Male; Middle Aged; Recurrence; Venous Thrombosis; Vitamin B 12

The aim of this study is to evaluate the plasma total homocysteine level in patients with venous thromboembolism (VTE) and to investigate the effect of different risk factors on plasma levels. Ninety-three-patients with VTE and 37-control participants diagnosed with other than VTE were included in the study. Plasma homocysteine levels and the factors affecting plasma homocysteine levels were evaluated. Plasma homocysteine level was higher among patients with VTE compared to the controls independent from vitamin B12 and folate levels. The prevalence of hyperhomocysteinemia in VTE was 63%. Plasma homocysteine level was higher in patients with PE than deep venous thrombosis (DVT; 23 ± 13.7 vs 16 ± 5.8 μmol/L, P = .018). With regression analysis hyperhomocysteinemia was found to be associated with a 4.8-fold increased risk of VTE. Hyperhomocysteinemia is a common and possibly modifiable risk factor that should be considered when screening patients with VTE. Secondary causes of hyperhomocysteinemia especially vitamin B12 deficiency should be monitored in patients with VTE to prevent recurrences.

Topics: Adult; Aged; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Prevalence; Risk Factors; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency

The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE in the absence of major risk factors and a homocysteine concentration above the 75th percentile of a reference group were asked to participate (hyperhomocysteinemic group). A similar study was conducted in a random sample of patients with a homocysteine below the 75th percentile of the reference group (normohomocysteinemic group). After informed consent was obtained, patients were randomized to daily multivitamin supplementation (5 mg folic acid, 50 mg pyridoxine, and 0.4 mg cyanocobalamin) or placebo and were followed for 2.5 years. End points were objectively diagnosed recurrent DVT or PE. A total of 701 patients were enrolled (360 in the hyperhomocysteinemic and 341 in the normohomocysteinemic group). The number of recurrent events of venous thrombosis was 43 of 353 in the vitamin group (54/1000 py) and 50 of 348 in the placebo group (64/1000 py). The hazard ratio associated with vitamin treatment was 0.84 (95% CI, 0.56-1.26): 1.14 (95% CI, 0.65-1.98) in the hyperhomocysteinemic group and 0.58 (95% CI, 0.31-1.07) in the normohomocysteinemic group. The results of our study do not show that homocysteine lowering by B vitamin supplementation prevents recurrent venous thrombosis.

Topics: Adolescent; Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Proportional Hazards Models; Pulmonary Embolism; Pyridoxine; Recurrence; Risk Factors; Thrombophilia; Treatment Failure; Venous Thrombosis; Vitamin B 12

Topics: Adolescent; Adult; Aged; Dietary Supplements; Double-Blind Method; Drug Combinations; Endothelium, Vascular; Folic Acid; Homocysteine; Humans; Middle Aged; Plasminogen Activator Inhibitor 1; Pulmonary Embolism; Pyridoxine; Time Factors; Tissue Plasminogen Activator; Treatment Outcome; Venous Thrombosis; Vitamin B 12; Vitamin B Complex

Elevated total homocysteine levels are associated with a higher risk for venous thromboembolism. Whether decreasing homocysteine levels with vitamin therapy reduces the risk for venous thromboembolism is not known.. To determine whether decreasing homocysteine levels alters the risk for symptomatic venous thromboembolism.. Secondary analysis of data from the randomized, placebo-controlled Heart Outcomes Prevention Evaluation 2 (HOPE-2) trial.. 145 clinical centers in 13 countries.. 5522 persons 55 years of age or older with known cardiovascular disease or diabetes mellitus and at least 1 other risk factor for vascular disease.. A daily supplement of 2.5 mg of folic acid, 50 mg of vitamin B(6), and 1 mg of vitamin B(12) or matching placebo for 5 years.. Prospectively diagnosed and confirmed symptomatic deep venous thrombosis or pulmonary embolism.. The geometric mean homocysteine level decreased by 2.2 micromol/L in the vitamin therapy group and increased by 0.80 micromol/L in the placebo group. Venous thromboembolism occurred in 88 participants during a mean follow-up of 5 years. The incidence rate of venous thromboembolism was the same in the vitamin therapy group and the placebo group (0.35 per 100 person-years; hazard ratio, 1.01 [95% CI, 0.66 to 1.53]). Vitamin therapy did not reduce the risk for deep venous thrombosis (hazard ratio, 1.04 [CI, 0.63 to 1.72]), pulmonary embolism (hazard ratio, 1.14 [CI, 0.57 to 2.28]), or unprovoked venous thromboembolism (hazard ratio, 1.21 [CI, 0.66 to 2.23]).. The proportion of patients with a previous episode of venous thromboembolism at enrollment was not known, and venous thromboembolism events were not centrally adjudicated.. Decreasing homocysteine levels with folic acid and vitamins B6 and B12 did not reduce the risk for symptomatic venous thromboembolism.

Topics: Aged; Female; Folic Acid; Humans; Hyperhomocysteinemia; Incidence; Male; Middle Aged; Prospective Studies; Pulmonary Embolism; Risk Factors; Thromboembolism; Venous Thrombosis; Vitamin B 12; Vitamin B 6

In the past years several case-control studies established the association of an elevated plasma homocysteine concentration and the risk of venous thromboembolism. It is still unclear if elevated homocysteine concentrations can cause venous thrombosis. The VITRO (VItamins and ThROmbosis) trial is the first multicenter, randomized, double-blind and placebo-controlled study to evaluate the effect of homocysteine-lowering therapy by means of 5 mg folic acid, 0.4 mg vitamin B12 and 50 mg vitamin B6. The study is a secondary prevention trial in 600 patients who suffered from a first episode of idiopathic deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. There will be 300 hyperhomocysteinemic and 300 normohomocysteinemic patients included, all with an objectivated venous thrombosis. The end point is recurrence of venous thrombosis.

Topics: Adult; Aged; Aged, 80 and over; Comorbidity; Double-Blind Method; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Hyperhomocysteinemia; Incidence; Male; Middle Aged; Netherlands; Prospective Studies; Pulmonary Embolism; Pyridoxine; Retrospective Studies; Secondary Prevention; Thrombophilia; Thrombophlebitis; Treatment Outcome; Ultrasonography; Venous Thrombosis; Vitamin B 12

A 27-year-old man presented with altered mental status and unilateral right lower limb swelling. Brain imaging and cerebrospinal fluid analysis were unremarkable. He reported history of nitrous oxide misuse after he recovered from his delirium. The diagnosis of drug induced psychosis was made. The right lower limb swelling was found to be due to extensive deep vein thrombosis. In another case, a 21-year-old woman presented with headache, vomiting and dipoplia. Brain imaging showed extensive cerebral venous sinus thrombosis. She also misused nitrous oxide. Both cases had low-normal vitamin B12 and elevated methylmalonic acid, consistent with nitrous oxide misuse. The woman was found to have elevated homocysteine because of functional vitamin B12 deficiency. Homocysteine was not measured in the man. Raised homocysteine is associated with increased thrombosis risk. Fourteen cases of nitrous oxide misuse associated arterial and venous thrombosis have been reported. These two cases highlighted the importance of inquiring about recreational drug use in young patients who presented with apparently unprovoked venous thromboembolism.

Topics: Adult; Female; Humans; Male; Nitrous Oxide; Substance-Related Disorders; Venous Thromboembolism; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Nitrous oxide, colloquially known as "whippets," is a commonly abused inhalant by adolescents and young adults. There are limited data describing the adverse effects of this abuse. We present a 16-year-old girl with no medical history who presented to the emergency department for confusion, hallucinations, weakness, and headaches. Imaging revealed extensive cerebral thrombosis. She had no prior history of venous or arterial thrombosis. Hypercoagulability workup demonstrated an elevated homocysteine level. She was treated with effective anticoagulation and vitamin B12 folate supplementation. To our knowledge, there are a very few cases in the medical literature of cerebral venous thrombosis following the use of nitrous oxide. The pathophysiology of the disorder appears to be linked to the metabolism of vitamin B12 inducing hyperhomocysteinemia and a procoagulant state.

Topics: Adolescent; Female; Humans; Intracranial Thrombosis; Nitrous Oxide; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

This case of recurrent cerebral venous thrombosis (CVT) highlights hyperhomocysteinemia in pernicious anemia due to vitamin B

Topics: Anemia, Pernicious; Folic Acid; Humans; Hyperhomocysteinemia; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency

Nitrous oxide is a commonly abused inhalant by adolescents and young adults. There is limited data describing the adverse effects of nitrous oxide abuse, known colloquially as "whippets". We present a 21-year-old female with no medical history who presented to the emergency department for confusion, hallucinations, weakness, and falls. She was accompanied by her roommates, who endorsed significant nitrous oxide abuse. Imaging revealed a large cerebral sinus venous thrombus with extension into the transverse sinus, sigmoid sinus and internal jugular vein. She had no prior history of venous or arterial thrombosis. Hypercoagulability workup demonstrated an elevated homocysteine level, elevated methylmalonic acid level, and normal cobalamin and folate levels. Additionally, she was found to be 11 weeks pregnant, with no prior spontaneous abortions. Genetic testing was significant for methylenetetrahydrofolate reductase polymorphisms. She was managed with enoxaparin, cobalamin and folate supplementation. Homocysteine and methylmalonic acid levels normalized after cessation of nitrous oxide use, with no recurrence of venous thrombosis. This case represents the first reported patient with a venous thrombus associated with nitrous oxide abuse.

Topics: Adult; Enoxaparin; Female; Folic Acid; Humans; Nitrous Oxide; Sinus Thrombosis, Intracranial; Venous Thrombosis; Vitamin B 12

Acute mesenteric venous thrombosis (AMVT) was first reported by Fagge and was recognised as a distinct clinical entity by Warreen in 1935. However, its pathogenesis is still unclear. Elevated plasma levels of homocysteine (Hcy) are associated with an increased risk of deep vein thrombosis. This case-control study examines the potential association among hyperhomocysteinaemia (hyper-Hcy), low serum folate and vitamin B(12) levels and the common C677T mutation of the MTHFR gene in patients with AMVT.. Sixty-three patients with AMVT and 75 sex- and age-matched healthy controls were recruited, and their plasma Hcy, folate and vitamin B(12) levels were measured by high performance liquid chromatography (HPLC) and immunological assays. The polymorphism of MTHFR C677T was detected by PCR-RFLP.. The mean plasma Hcy levels were significantly higher in patients with AVMT compared with controls (23.5 standard deviation (S.D.) 8.8 vs. 12.6+/-6.6micromoll(-1), P<0.01). The fasting Hcy correlated negatively with folate (AMVT: r=-0.42, P<0.01;. r=-0.40, P<0.01). The frequency of homozygous (TT) genotype in MTHFR C677T mutation was significantly higher in patients with AMVT than that in control subjects (33% vs. 17%; chi square (chi(2))=6.31, P<0.05; odds ratio (OR)=2.80; 95% confidence interval (CI): 1.25-6.25). Compared with the control subjects, the mean serum vitamin B(12) levels were lower in patients, but it was not statistically significant (365+/-88pmoll(-1) vs. 408+/-108pmoll(-1), P>0.05).. Hyper-Hcy and low serum folate levels were associated with an increased risk of AMVT. The homozygous (TT) genotype of MTHFR gene mutation may be a crucial hereditary risk factor in the development of AMVT for a Chinese population.

Topics: Acute Disease; Adult; Aged; Asian People; Biomarkers; Case-Control Studies; Chi-Square Distribution; China; Chromatography, High Pressure Liquid; Down-Regulation; Female; Folic Acid; Genetic Predisposition to Disease; Homocysteine; Homozygote; Humans; Hyperhomocysteinemia; Immunoassay; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Mutation; Odds Ratio; Phenotype; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Risk Assessment; Risk Factors; Venous Thrombosis; Vitamin B 12; Young Adult

Topics: Homocysteine; Humans; Hyperhomocysteinemia; Metformin; Venous Thrombosis; Vitamin B 12; Vitamin B 12 Deficiency

Hyperhomocysteinemia (hyper-Hcy) is a known risk factor for venous thrombosis, but few studies document the risk in puerperal cerebral venous thrombosis (CVT). Nutritional folate and vitamin B(12) deficiency can cause hyper-Hcy and pregnancy may contribute to this deficiency. We studied the association of plasma total homocysteine (tHcy), folate and vitamin B(12) levels with puerperal CVT through a case-control study.. Sixty women with puerperal CVT and 64 healthy puerperal controls were recruited. Plasma fasting tHcy was estimated by high pressure liquid chromatography using coulometric electrochemical detection. Vitamin B(12) and folate were measured by radioimmunoassay. Risk of puerperal CVT was estimated for each of the three variables.. Adjusted odds ratio for the risk of puerperal CVT with hyper-Hcy (>90th percentile) was 10.8 (95% CI: 4.0-29.4; adjusted for vitamin B(12) and folate levels). Low folate and vitamin B(12) levels (<10th percentile) did not increase the risk for puerperal CVT. There was a significant inverse correlation between folate and tHcy levels (rho=-0.471, p<0.001).. Hyperhomocysteinemia is associated with an increased risk of puerperal CVT occurring in Indian women and low folate levels contribute significantly to hyper-Hcy. Regular antenatal folate and vitamin B(12) supplementation is likely to lower puerperal tHcy levels, but its clinical benefit needs to be tested by large therapeutic trials.

Topics: Adolescent; Adult; Confidence Intervals; Female; Folic Acid; Homocysteine; Humans; Intracranial Thrombosis; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Odds Ratio; Prothrombin; Puerperal Disorders; Risk; Risk Assessment; Statistics as Topic; Venous Thrombosis; Vitamin B 12

To test the association between hyperhomocysteinemia (HHC) and deep venous thrombosis (DVT) of lower extremities in Tunisians.. This case-control study included 90 patients with DVT of the lower extremities and 160 healthy controls. Plasma homocysteine, vitamin B(12) and folate were determined using immunoenzymatic methods. Logistic regression models were performed to test whether the association between HHC and DVT is independent and to precise determinants of HHC in DVT patients.. Plasma total homocysteine concentrations were significantly higher in patients with DVT (17.4+/-11.5 micromol/L) and in patients with idiopathic DVT (15.2+/-6.4 micromol/L) as compared to controls (11.5+/-3.3 micromol/L). HHC was significantly associated (p<0.001) with all DVT (OR, 8.82; 95% CI, 3.96-19.6) as well as idiopathic DVT (OR, 7.40; 95% CI, 3.01-10.8). These associations persisted after adjustment for several thrombosis risk factors. In patients with DVT, HHC was related to folate and vitamin B(12) concentrations, but neither to the type of occurrence nor to the recurrence of DVT.. HHC is independently associated with first DVT of lower extremities in Tunisians. Homocysteine should be assessed in patients with DVT and the effect of vitamin B supplementation should be tested among them.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Creatinine; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Leg; Male; Middle Aged; Prevalence; Recurrence; Tunisia; Venous Thrombosis; Vitamin B 12

Topics: Aged; Female; Folic Acid; Humans; Hyperhomocysteinemia; Incidence; Male; Middle Aged; Prospective Studies; Pulmonary Embolism; Risk Factors; Thromboembolism; Venous Thrombosis; Vitamin B 12; Vitamin B 6

Moderate hyperhomocysteinemia and B vitamins deficiency are thought to be risk factors for venous thromboembolism (VTE). The causality and independence of those associations are still questioned.. We measured fasting serum total homocysteine, folates, and vitamin B12 levels as well as 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T genotypes in 467 patients hospitalized with a first well-documented deep vein thrombosis and/or pulmonary embolism not related to a major acquired risk factor and 467 controls matched for gender and age.. Mild hyperhomocysteinemia, low serum folates, and vitamin B12 were associated with VTE independently of each other. In multivariate analysis, odds ratios (OR) (95% CI) for VTE associated with mild hyperhomocysteinemia (>15 micromol L(-1)), low serum folates (< or = 4.9 nmol L(-1)), and vitamin B12 (< or = 253 pmol L(-1)) were 1.48 (1.05-2.08), 3.14 (1.35-7.32) and 1.42 (1.03-1.98), respectively. An MTHFRC677T genotype was not significantly associated with VTE; OR (95% CI): 1.13 (0.70-1.81). The current data provides further knowledge in the complex relationship between hyperhomocysteinemia, low vitamin levels, and VTE.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Genotype; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Prospective Studies; Pulmonary Embolism; Risk Factors; Venous Thrombosis; Vitamin B 12

Hyperhomocysteinaemia is a well-known risk factor for venous thromboembolic disease (VTD). However, it is not clear whether homocysteine (Hc) itself or a related metabolite or a cofactor is primarily responsible for VTD. We carried out a case-control study to investigate whether vitamin concentrations that are involved in the Hc metabolism are associated or not with an elevated risk of VTD.. Case-control study.. We measured serum vitamin B12, folate, creatinine and albumin concentrations and plasma Hc concentrations in 101 consecutive patients with VTD, diagnosed by image tests and 101 control subjects, matched for age and sex.. Serum vitamin B12 concentrations were significantly lower in VTD patients than in the control subjects. There were no differences in plasma Hc or serum folate concentrations between the groups. Among the male subgroup aged more than 70 years, serum vitamin B12 concentrations were significantly lower (240.88 +/- 103.07 vs. 421.20 +/- 314.31 pmol L(-1); P = 0.03) and plasma Hc concentrations were significantly higher (13.1 +/- 4.18 vs. 10.56 +/- 3.06 micromol L(-1); P =0.04) in VTD patients than in the control group. On multivariate analysis, in patients aged more than 70 years, serum vitamin B12 concentrations were independently associated with VTD. Compared with the highest quartile of vitamin B12 (>512.6 pmol L(-1)) the odds ratio (OR) for VTD in the lowest quartile (<230.9 pmol L(-1)) was 3.8 (95% CI 1.44-10.18; P = 0.01). In the VTD group, lowest vitamin B12 concentrations (percentile 10 <152.8 pmol L(-1)) were associated with the factor V Leiden mutation (OR = 6.07, 95% CI 0.93-38.55; P = 0.04).. Measuring vitamin B12 concentrations in elderly males may help in identifying people at risk of venous thromboembolism in our population.

Topics: Age Factors; Aged; Biomarkers; Case-Control Studies; Creatinine; Female; Folic Acid; Homocysteine; Humans; Logistic Models; Male; Risk Assessment; Thromboembolism; Venous Thrombosis; Vitamin B 12; Vitamin B Deficiency

Hyperhomocysteinemia is known to be associated with arterial occlusive vascular disease and venous thrombosis. Here, we report a young ethnic Omani patient with recurrent venous thrombosis who was found to be heterozygous for 677C-T mutation in the methyltetrahydrofolate reductase (MTHFR) enzyme. Moderate hyperhomocystenemia was also observed, in the presence of normal red cell folate and serum B12 levels. No other documented marker of hereditary thrombophilia could be demonstrated in this patient, in spite of extensive investigation on multiple occasions.

Topics: Adult; Arterial Occlusive Diseases; Erythrocytes; Folic Acid; Heterozygote; Humans; Hyperhomocysteinemia; Iliac Vein; Male; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Popliteal Vein; Vena Cava, Inferior; Venous Thrombosis; Vitamin B 12

We describe a family in which four generations (eight members) had deep vein thrombosis of the lower limb and three of the alive members had documented hyperhomocysteinemia. In addition, one of the family members had evidence of arterial thrombosis in the form of cerebral infarcts. Interestingly, all affected members in the family were males.

Topics: Adult; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nitroprusside; Pedigree; Venous Thrombosis; Vitamin B 12; Warfarin

High plasma levels of total homocysteine (tHcy) are a risk factor for deep vein thrombosis. Because no information on the relationship between cerebral vein thrombosis and hyperhomocysteinemia is available, a case-control study of 121 patients with a first episode of cerebral vein thrombosis and 242 healthy control subjects was carried out. Fasting plasma levels of tHcy and their postmethionine load (PML) increments, together with other laboratory markers of thrombophilia, were measured in plasma or DNA. Hyperhomocysteinemia (high fasting tHcy and/or PML increments) was diagnosed in 33 patients (27%) and 20 control subjects (8%) (odds ratio, 4.2; 95% confidence interval [CI], 2.3-7.6). Low levels of serum folate and the 677TT methylene tetrahydrofolate reductase were associated with hyperhomocysteinemia, but in a multivariate model hyperhomocysteinemia only was associated with an increased risk of cerebral vein thrombosis. Oral contraceptive intake was associated with the disease with an odds ratio of 6.1 (95% CI, 3.3-11.0). The combined presence of the latter and hyperhomocysteinemia increased the risk of the disease with an odds ratio of 19.5 (95% CI, 5.7-67.3). In conclusion, hyperhomocysteinemia is associated with a 4-fold increased risk of cerebral vein thrombosis; whether or not its correction with vitamins reduces the risk of the disease remains to be demonstrated.

Topics: Adolescent; Adult; Case-Control Studies; Child; Female; Folic Acid; Homocystine; Humans; Hyperhomocysteinemia; Intracranial Thrombosis; Male; Methionine; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Oxidoreductases Acting on CH-NH Group Donors; Risk Factors; Thrombophilia; Venous Thrombosis; Vitamin B 12

To study the relationship between plasma homocysteine (Hcy) level and deep-vein thrombosis (DVT), and analyze the interaction of Hcy, folate and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in patients with DVT.. Totally 69 patients with DVT and 111 healthy controls were included in our case-control study. We determined the MTHFR C677T genotypes by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP), measured the serum folate and vitamin B12 by radioimmunoassay (RIA), and measured the plasma homocysteine level by fluorescence polarization immunoassay (FPIA).. The frequency of the MTHFR C677T TT genotype had no significant difference between DVT group and control group (P > 0.05). The plasma Hcy level was significantly higher in DVT group than in control group (13.03 +/- 8.74 mumol/L vs 10.14 +/- 4.30 mumol/L, P < 0.05). Both serum folate and VitB12 of patients with DVT were not significantly different from those of controls. The odds radios (OR) of hyperhomocysteinemia for DVT was 2.53 (95% CI 1.08-5.92). The interaction of low folate level and TT genotype increased the risk of DVT (OR = 3.12, 95% CI 1.17-8.38).. Hyperhomocysteinemia may be an independent risk factor for DVT in Han nationality, while serum folate level and MTHRF C677T genotype are not. An interaction between serum folate level and MTHFR genotype that affect the Hcy level is an important risk factor for DVT.

Topics: Adult; Aged; Aged, 80 and over; Female; Folic Acid; Genetic Predisposition to Disease; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Restriction Fragment Length; Venous Thrombosis; Vitamin B 12

The main issue in venous thrombotic events is their etiology. Several clinical and/or biological data can be helpful in that research. In the two cases we report here, a macrocytic anemia led to the diagnosis of probably acquired hyperhomocysteinemia.. a 24-year-old man was admitted for severe anemia and a superior vena cava syndrome. Biological data showed megaloblastic anemia and mild features of blood destruction that were explained by a pernicious anemia. Second case: a 35-year-old man had two deep venous thrombotic events in one year (involving the right leg, then the left leg); biological findings showed a macrocytic mild anemia that was diagnosed as a pernicious anemia. In both of the patients, deep venous thrombosis was mainly explained by a hyperhomocysteinemia that was a consequence of vitamin B12 deficiency. The two patients improved under anticoagulant treatment combined with subcutaneous vitamin B12.. Pernicious anemia can cause acquired hyperhomocysteinemia, which is considered a risk factor for deep venous thrombosis. Thus, the connectivity of these conditions should remain in the practitioner's mind, especially when thrombosis occurs along with a macrocytic anemia.

Topics: Adult; Anemia, Pernicious; Humans; Hyperhomocysteinemia; Injections, Subcutaneous; Male; Risk Factors; Venous Thrombosis; Vitamin B 12

Elevated plasma levels of total homocysteine (tHcy) before and after an oral methionine load (PML) are associated with an elevated risk of deep-vein thrombosis (DVT). We investigated whether plasma levels of B vitamins that are involved in Hcy metabolism are associated with an elevated risk of DVT.. We compared 397 cases with previous DVT with 585 matched healthy controls. The plasma levels of folate, vitamin B(12), vitamin B(6,), and fasting and PML tHcy were measured. The ORs for DVT associated with high (>95th percentile) fasting levels and PML increases of tHcy were 2.1 (95% CI, 1.2 to 3.4) and 2.4 (95% CI, 1.5 to 3.9) after adjustment for established risk factors for DVT. Fasting plasma levels and PML increases in tHcy correlated negatively with vitamin levels. The crude OR for folate levels in the lowest quartile compared with the highest was 1.5 (95% CI, 1.1 to 2.1), and that for B(6) levels in the lowest and second quartiles compared with the highest was 1.5 (95% CI, 1.0 to 2.1). However, after adjustment for established risk factors and fasting and PML tHcy, the ORs for B(6) levels in the lowest and second quartiles only remained statistically significant (lowest quartile: OR, 1.8; 95% CI, 1.2 to 2.8; second quartile, OR, 1.9; 95% CI, 1.3 to 2.9).. High fasting and PML tHcy and low vitamin B(6) plasma levels are associated with an elevated risk for DVT independently of established risk factors for DVT. The association of low vitamin B(6) levels with the risk for DVT is independent of fasting and PML tHcy levels.

Topics: Adolescent; Adult; Aged; Child; Fasting; Female; Folic Acid; Homocysteine; Humans; Male; Methionine; Middle Aged; Risk Factors; Venous Thrombosis; Vitamin B 12; Vitamin B 6

Topics: Adult; Anticoagulants; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Recurrence; Risk Factors; Venous Thrombosis; Vitamin B 12