Characteristics of Deep venous thrombosis in Tunisian Behçet's disease patients. M H. Houman Department of internal medicine University hospital of la Rabta Tunis Tunisia

Objectives: To determine the frequency, the clinical characteristics and course of DVT in BD Tunisian Patients to define a subgroup of patients at high risk for this complication.

Patients and Methods: Retrospective review of 260 Patients with BD (ISG criteria) seen in the Department of Internal Medicine of the University Hospital La Rabta in Tunisia, from 1990 to 2006.

Patients and Methods: The diagnosis of DVT was made in all cases using conventional venous angiography, venous ultrasonography and/or thoracic or abdominal computed tomography. Patients were divided in two subgroups according to the occurrence of DVT.

Patients and Methods: Protein S, protein C and AT: 51 patients aCL and antiß2GP1 Abs: 27 patients HLA B51: 41 patients. data were analyzed using SPSS 11.0.

Results

Results 86 patients (33%) had DVT. 74 men and 12 women (M/F = 6.16). Mean age at DVT onset: 29.05 years. Mean delay: 4 years after BD onset In 11 cases, DVT revealed BD

158 locations of DVT were detected. Results 158 locations of DVT were detected. Nbr patients: 86 Nbr locations 37 (43.02%) 1 33 (38.37%) 2 10 (11.63%) 3 5 (5.81%) 4 1 (1.16%) 5 57% of our patients showed more than 1 location

Results: 158 locations of DVT were detected. Nbr (158) % Lower extremities 86 54.43 inferior vena cava 18 11.4 Superior vena cava 17 10.76 Pulmonary embolism 16 10.13 Cerebral veins 13 8.23 Jugular Veins 4 2.53 Sup Hepatic Veins 3 1.9 Upper extremities 1 0.63

Lower extremity DVT

Results: IgG Acl + in 8/27 aß2GP1 + in 1 patient Protein C deficiency 2 cases Protein S in one case. No patient with Anti-thrombin deficiency No difference between patients with/without DVT

Results: Treatment All patients: anticoagulant agents and colchicine Corticosteroids: prescribed to 51 (61.4%) patients and monthly IV pulses of cyclophosphamide were added to 25 (30%) cases

Results: Course of DVT Complete clinical recovery:30 cases (47.6%) Available in 63 cases Complete clinical recovery:30 cases (47.6%) Chronic venous insufficiency:12 (19%). Recurrence of DVT: 21 (33.4%) 2 patient died.

Results: DVT Recurrence 15/54 (27.7%) patients treated with corticosteroids, 6/32 (18.7%)patients with no corticosteroids (p = 0.001).

Results: patients CC + 68 CC- 17 Lower extremities 71 14 inferior vena cava 18 Superior vena cava Pulmonary embolism 15 1 Cerebral veins 12 Jugular Veins 4 Sup Hepatic Veins 3 Upper extremities

Results: 0.762 4 (66.7%) 14 (60.9%) HLA B51 27 (39.7%) Neurological 27 (39.7%) Neurological 0.130 8 (47%) 19 (27.9%) Articular 0.007 1 (6.3%) 27 (40.3%) Ocular 0.144 9 (90%) 33 (67.3%) PT 0.599 3 (17.6%) 13 (19%) EN 0.552 11 (64.7%) 49 (72%) PSF 0.575 15 (88.2%) 61 (89.7%) AG 0.407 31 24.33 Age 0.446 14 (82.4%) 59 (86.8%) Males P Corticosteroids 17 Corticosteroids + 68

Results: Clinical features of BD in patients with and without DVT 174 With DVT 86 P Males 114 (65.9%) 74 (86%) 0.001 Age 28.6 29.55 0.482 AG 138 (80.2%) 77 (89.5%) 0.059 PSF 122 (70.5) 61 (70.9) 0.946 EN 39 (22.5) 16 (18.6) 0.465 PT 65 (58) 42 (70) 0.123 Ocular 98 (57) 28 (33.3) <0.0001 Articular 73 (42) 27 (32.5) 0.093 Neurological 36 (20.8) 27 (31.4) 0.061 Entero 3 (1.7) 1 (1.2) 0.749 HLA B51 41 (50.6) 18 (62.1) 0.289

Conclusion In our series Frequency of DVT is rather high: 33% 57% of our patients showed more than 1 location Lower extremities the + frequent location: 54.4% Recurrence of DVT was seen in 33.4% of cases DVT recurrence significantly + frequent in patients in whom corticosteroids were added!!

Conclusion In our series No correlation with aCL and aß2GP1 Abs No correlation with Prot S, C & AT deficiencies Hence, thrombosis in BD seems to be related more to vasculitis than to clotting disorders.

Conclusion our results showed also that DVT occurs + frequently in males with GA & Neuro involvement Less frequently in those with ocular disease