Clinical Rheumatology

, Volume 27, Issue 2, pp 201–205

Treatment of venous thrombosis associated with Behcet’s disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation

  • Joong Kyong Ahn
  • You Sun Lee
  • Chan Hong Jeon
  • Eun-Mi Koh
  • Hoon-Suk Cha
Original Article

Abstract

The aim of this study was to compare the efficacy of immunosuppressive therapy alone with that of combination therapy involving immunosuppressants and anticoagulation for the treatment of venous thrombosis in Behcet’s disease (BD). A retrospective analysis was made of 37 patients with venous thrombosis in BD. BD patients with venous thrombosis were divided into three groups: one group (N = 16) received immunosuppressive therapy alone, another group (N = 17) received immunosuppressant and anticoagulation combination therapy, and the third group (N = 4) received anticoagulation therapy only. Clinical and laboratory parameters and the recurrence of venous thrombosis were assessed. Venous thrombosis in BD appeared to have a more diffuse pattern than idiopathic type and a predilection for lower limbs. The most commonly involved sites were the superficial and common femoral veins. Recurrence of venous thrombosis occurred in two cases in the immunosuppressant group (12.5%), one case in the combination therapy group (5.9%), and three cases in the anticoagulant group (75%). No significant difference was found between recurrence in the immunosuppressant and combination therapy groups. Acute phase reactants were elevated in all six patients at the time of venous thrombosis recurrence. Our study suggests that immunosuppressive therapy is essential and that anticoagulation therapy might not be required for the treatment of deep venous thrombosis associated with BD.

Keywords

Anticoagulation Behcet’s disease Deep venous thrombosis Immunosuppression 

References

  1. 1.
    Sakane T, Takeno M, Suzuki N, Inaba G (1999) Behcet’s disease. N Engl J Med 341:1284–1291PubMedCrossRefGoogle Scholar
  2. 2.
    Gurler A, Boyvat A, Tursen U (1997) Clinical manifestations of Behcet’s disease: an analysis of 2147 patients. Yonsei Med J 38:423–427PubMedGoogle Scholar
  3. 3.
    Zouboulis CC, Kotter I, Djawari D, Kirch W, Kohl PK, Ochsendorf FR, Keitel W, Stadler R, Wollina U, Proksch E, Sohnchen R, Weber H, Gollnick HP, Holzle E, Fritz K, Licht T, Orfanos CE (1997) Epidemiological features of Adamantiades-Behcet’s disease in Germany and in Europe. Yonsei Med J 38:411–422PubMedGoogle Scholar
  4. 4.
    Sarica-Kucukoglu R, Akdag-Kose A, Kayabal IM, Yazganoglu KD, Disci R, Erzengin D, Azizlerli G (2006) Vascular involvement in Behcet’s disease: a retrospective analysis of 2319 cases. Int J Dermatol 45:919–921PubMedCrossRefGoogle Scholar
  5. 5.
    Kural-Seyahi E, Fresko I, Seyahi N, Ozyazgan Y, Mat C, Hamuryudan V, Yurdakul S, Yazici H (2003) The long-term mortality and morbidity of Behcet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center. Medicine (Baltimore) 82:60–76CrossRefGoogle Scholar
  6. 6.
    Koc Y, Gullu I, Akpek G, Akpolat T, Kansu E, Kiraz S, Batman F, Kansu T, Balkanci F, Akkaya S et al (1992) Vascular involvement in Behcet’s disease. J Rheumatol 19:402–410PubMedGoogle Scholar
  7. 7.
    Houman MH, Ben Ghorbel I, Khiari Ben Salah I, Lamloum M, Ben Ahmed M, Miled M (2001) Deep vein thrombosis in Behcet’s disease. Clin Exp Rheumatol 19:S48–S50PubMedGoogle Scholar
  8. 8.
    Kabbaj N, Benjelloun G, Gueddari FZ, Dafiri R, Imani F (1993) [Vascular involvements in Behcet disease. Based on 40 patient records]. J Radiol 74:649–656PubMedGoogle Scholar
  9. 9.
    Calamia KT, Schirmer M, Melikoglu M (2005) Major vessel involvement in Behcet disease. Curr Opin Rheumatol 17:1–8PubMedCrossRefGoogle Scholar
  10. 10.
    Radke PW, Schwarz ER, Groesdonk H, Graf J, Janssens U (2001) Thrombosis in Behcet’s disease: report of a case followed by a systematic review using the methodology of evidence-based medicine. J Thromb Thrombolysis 11:137–141PubMedCrossRefGoogle Scholar
  11. 11.
    Anonymous (1990) Criteria for diagnosis of Behcet’s disease. International Study Group for Behcet’s Disease. Lancet 335:1078–1080Google Scholar
  12. 12.
    Espinosa G, Font J, Tassies D, Vidaller A, Deulofeu R, Lopez-Soto A, Cervera R, Ordinas A, Ingelmo M, Reverter JC (2002) Vascular involvement in Behcet’s disease: relation with thrombophilic factors, coagulation activation, and thrombomodulin. Am J Med 112:37–43PubMedCrossRefGoogle Scholar
  13. 13.
    Probst K, Fijnheer R, Rothova A (2004) Endothelial cell activation and hypercoagulability in ocular Behcet’s disease. Am J Ophthalmol 137:850–857PubMedCrossRefGoogle Scholar
  14. 14.
    Leiba M, Seligsohn U, Sidi Y, Harats D, Sela BA, Griffin JH, Livneh A, Rosenberg N, Gelernter I, Gur H, Ehrenfeld M (2004) Thrombophilic factors are not the leading cause of thrombosis in Behcet’s disease. Ann Rheum Dis 63:1445–1449PubMedCrossRefGoogle Scholar
  15. 15.
    Gurgey A, Balta G, Boyvat A (2003) Factor V Leiden mutation and PAI-1 gene 4G/5G genotype in thrombotic patients with Behcet’s disease. Blood Coagul Fibrinolysis 14:121–124PubMedCrossRefGoogle Scholar
  16. 16.
    Merkel PA, Lo GH, Holbrook JT, Tibbs AK, Allen NB, Davis JC Jr, Hoffman GS, McCune WJ, St Clair EW, Specks U, Spiera R, Petri M, Stone JH (2005) Brief communication: high incidence of venous thrombotic events among patients with Wegener granulomatosis: the Wegener’s Clinical Occurrence of Thrombosis (WeCLOT) Study. Ann Intern Med 142:620–626PubMedGoogle Scholar
  17. 17.
    Goldhaber SZ (1998) Pulmonary embolism. N Engl J Med 339:93–104PubMedCrossRefGoogle Scholar
  18. 18.
    Duzgun N, Ates A, Aydintug OT, Demir O, Olmez U (2006) Characteristics of vascular involvement in Behcet’s disease. Scand J Rheumatol 35:65–68PubMedCrossRefGoogle Scholar
  19. 19.
    Mader R, Ziv M, Adawi M, Mader R, Lavi I (1999) Thrombophilic factors and their relation to thromboembolic and other clinical manifestations in Behcet’s disease. J Rheumatol 26:2404–2408PubMedGoogle Scholar
  20. 20.
    Silingardi M, Salvarani C, Boiardi L, Accardo P, Iorio A, Olivieri I, Cantini F, Salvi F, La Corte R, Triolo G, Ciccia F, Ghirarduzzi A, Filippini D, Paolazzi G, Iori I (2004) Factor V Leiden and prothrombin gene G20210A mutations in Italian patients with Behcet’s disease and deep vein thrombosis. Arthritis Rheum 51:177–183PubMedCrossRefGoogle Scholar
  21. 21.
    Hooten WM, O’Duffy JD (1998) 29-year-old man with recurrent deep venous thrombosis and skin lesions. Mayo Clin Proc 73:463–466PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Joong Kyong Ahn
    • 1
  • You Sun Lee
    • 1
  • Chan Hong Jeon
    • 2
  • Eun-Mi Koh
    • 1
  • Hoon-Suk Cha
    • 1
  1. 1.Department of Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Internal MedicineSoonchunhyang University College of MedicineGyeonggi-doSouth Korea

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