Deep vein thrombosis risk factors
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep vein thrombosis Microchapters |
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Risk Factors |
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Deep vein thrombosis risk factors On the Web |
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Risk calculators and risk factors for Deep vein thrombosis risk factors |
Overview
The identification and minimization of risk factors is important in the management of DVT. The duration of anticoagulation is guided by the presence of thrombophilic risk factors.
Risk Factors
Recently a research group[1]. has postulated a risk-prediction algorithm for VTE. This algorith helps:
- Estimates individual risk for VTE
- To start prophylaxis in patients at risk for VTE.
This algorithm does not work in these conditions:
- History of venous thrombosis
- Family history of venous thrombosis.
- Pregnant patients
- Patients on Anticoagulations
- Symptoms suggestive of thrombosis.
The various variables that are taken into account are as follows
| Age |
| Body mass index |
| Smoking status (non-smoker; ex-smoker; light, moderate, or heavy smoker) |
| Townsend deprivation score |
| Varicose veins |
| Congestive cardiac failure |
| Rheumatoid arthritis |
| Chronic renal disease |
| Inflammatory bowel disease |
| Cancer:(lung, gastrointestinal, pancreas, renal, breast, prostate, other) |
| Recent hospital admission |
| Recent hip fracture or hip surgery (or both) |
| Current use of antipsychotic drugs:(none, atypical, typical) |
| Current use of tamoxifen |
| Current use of hormone replacement therapy: (none, equine or non-equine hormone replacement therapy) |
| Use of antiplatelets |
| Cardiovascular disease(stroke, transient ischaemic attack, or coronary artery disease) |
| Atrial fibrillation |
| Asthma |
| Chronic obstructive pulmonary disease |
| Family history of venous thromboembolism |
To calculate the risk prediction click here
Modifiable Risk Factors
Modifiable risk factors are reversible based upon lifestyle/behavior modification.
- Obesity: Obesity is defined as a body-mass index (BMI) above 30 kg/m2. Underweight subjects have reduced risk while obese people have significant risk for DVT, and/or PE.[2] [3] [4]
- Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:[2]
- Smoking
- Use of oral contraceptives
- Prolonged air travel: However, travel by air increases the risk to the same extent as travel by bus, train or car, suggesting that the increased risk of air travel is due primarily to prolonged immobility. [5]
- Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:[2]
- Homocysteine: Elevated homocysteine has been reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.[6]
- Smoking: Significantly increases the risk of DVT, particularly in women who are taking oral contraceptive pills.
Non-Modifiable Risk Factors
- Age: The risk of DVT increases with age.
- Heart failure
- Thrombophilia or hypercoagulable state
- Polycythemia vera
Temporary Risk Factors
- A previous history of DVT (this is the most significant risk factor). Cushman et al. noted a 28-day case-fatality rate of 9.4% after first-time DVT and 15.1% after first-time PE.[7]
- Injury to a deep vein from surgery, a fracture, or other trauma, especially a paralytic spinal cord injury. [8]
- Prolonged Immobilization causes stasis in the deep veins which may occur after surgery, with prolonged bedrest, or prolonged seating during travel.
- Pregnancy and the peri-partum period
- Active cancer
- Central venous catheter
Wells Score
The Wells score is simple, and it is the most commonly used clinical risk prediction tool to evaluate the need for further testing in patients suspected to have deep vein thrombosis and pulmonary embolism.[9][10][11][12]
| Variable | Wells[11] |
|---|---|
| Clinically suspected DVT (leg swelling, pain with palpation) | 3.0 |
| Alternative diagnosis is less likely than PE | 3.0 |
| Immobilization/surgery in previous four weeks | 1.5 |
| Previous history of DVT or PE | 1.5 |
| Tachycardia (heart rate more than 100 bpm) | 1.5 |
| Malignancy (treatment for within 6 months, palliative) | 1.0 |
| Hemoptysis | 1.0 |
Wells Criteria [11][12]
- The following scoring system is used for assessment of risk[13] and need for further testing with D-dimer or CT scan:
- Score > 6.0 - High probability (~59%).
- Score 2.0 to 6.0 - Moderate probability (~29%).
- Score < 2.0 - Low probability (~15%).
References
- ↑ Hippisley-Cox J, Coupland C (2011). "Development and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism: prospective cohort study.". BMJ 343: d4656. doi:10.1136/bmj.d4656. PMID 21846713.
- ↑ 2.0 2.1 Holst AG, Jensen G, Prescott E (2010). "Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study.". Circulation 121 (17): 1896-903. doi:10.1161/CIRCULATIONAHA.109.921460. PMID 20404252.
- ↑ Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D (2011). "The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population.". Metab Syndr Relat Disord 9 (3): 197-201. doi:10.1089/met.2010.0117. PMID 21352080.
- ↑ Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O et al. (2008). "Overweight, obesity, and the risk of recurrent venous thromboembolism.". Arch Intern Med 168 (15): 1678-83. doi:10.1001/archinte.168.15.1678. PMID 18695082.
- ↑ http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
- ↑ Cattaneo M (2006). "Hyperhomocysteinemia and venous thromboembolism.". Semin Thromb Hemost 32 (7): 716-23. doi:10.1055/s-2006-951456. PMID 17024599.
- ↑ Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al. (2004). "Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology.". Am J Med 117 (1): 19-25. doi:10.1016/j.amjmed.2004.01.018. PMID 15210384.
- ↑ Anderson FA, Spencer FA (June 2003). "Risk factors for venous thromboembolism". Circulation 107 (23 Suppl 1): I9–16. doi:10.1161/01.CIR.0000078469.07362.E6. PMID 12814980.
- ↑ Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D'Ovidio R, Cogo A, Prandoni P (May 1995). "Accuracy of clinical assessment of deep-vein thrombosis". Lancet 345 (8961): 1326–30. PMID 7752753. Retrieved on 2012-04-26.
- ↑ Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (1998). "Use of a clinical model for safe management of patients with suspected pulmonary embolism". Ann Intern Med 129 (12): 997-1005. PMID 9867786.
- ↑ 11.0 11.1 11.2 Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (2000). "Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer.". Thromb Haemost 83 (3): 416-20. PMID 10744147.
- ↑ 12.0 12.1 Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ (2001). "Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer". Ann Intern Med 135 (2): 98-107. PMID 11453709.
- ↑ Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD (2007). "Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators". Radiology 242 (1): 15-21. doi:10.1148/radiol.2421060971. PMID 17185658.
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