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__NOTOC__
__NOTOC__
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}  [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]
{| class="infobox" style="float:right;"
 
|-
| [[File:Siren.gif|30px|link=Deep vein thrombosis resident survival guide]]|| <br> || <br>
| [[Deep vein thrombosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; '''Associate Editor(s)-In-Chief:''' {{CZ}}  [[User:Kashish Goel|Kashish Goel, M.D.]]; '''Assistant Editor(s)-In-Chief:''' [[User:Justine Cadet|Justine Cadet]]; {{Rim}}
{{Deep vein thrombosis}}
{{Deep vein thrombosis}}


==Overview==
==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 [[Thrombophilia#Treatment|thrombophilic risk factors]].
Venous thromboembolism (VTE) consists of [[deep vein thrombosis]] (DVT), [[pulmonary embolism]] (PE), or both.  In these chapters on VTE, the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing [[venous thrombosis]].  The word triggers refer to those factors in the patients immediate history or environment that may have led to the occurrence of the [[venous thrombosis]].  The risk factors for VTE are a constellation of predisposing conditions which stem from the three principles of [[Virchow's triad]]: stasis of the blood flow, damage to the vascular [[endothelial cell]]s, and [[hypercoagulability]].  The risk factors for VTE can be classified as temporary, modifiable and non-modifiable.  It is suggested that [[venous thrombosis]] also shares risk factors with [[arterial thrombosis]], such as [[obesity]], [[hypertension]], [[smoking]], and [[diabetes mellitus]].<ref name="pmid20620709">{{cite journal| author=Goldhaber SZ| title=Risk factors for venous thromboembolism. | journal=J Am Coll Cardiol | year= 2010 | volume= 56 | issue= 1 | pages= 1-7 | pmid=20620709 | doi=10.1016/j.jacc.2010.01.057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620709  }} </ref>


==Risk Factors==
==Risk Factors==
Shown below is a list of predisposing factors to [[VTE]].<ref name="pmid12814980">{{cite journal| author=Anderson FA, Spencer FA| title=Risk factors for venous thromboembolism. | journal=Circulation | year= 2003 | volume= 107 | issue= 23 Suppl 1 | pages= I9-16 | pmid=12814980 | doi=10.1161/01.CIR.0000078469.07362.E6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12814980  }} </ref><ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870  }} </ref> The risk factors are classified as moderate or weak depending on how strongly they predispose for a VTE.
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Moderate risk factors''' || style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Weak risk factors'''
|-
|  style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |
❑ [[Chemotherapy]]<br>
❑ [[Chronic heart failure]]<br>
❑ [[Respiratory failure]]<br>
❑ [[Hormone replacement therapy]]<br>
❑ [[Cancer]]<br>
❑ [[Oral contraceptive pills]] <br>
❑ [[Stroke]] <br>
❑ [[Pregnancy]] <br>
❑ [[Postpartum]] <br>
❑ Prior history of [[VTE]] <br>
❑ [[Thrombophilia]] <br>
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ Advanced [[age]] <br>
❑ [[Laparoscopic surgery]] <br>
❑ Prepartum <br>
❑ [[Obesity]] <br>
❑ [[Varicose veins]]
|}
The risk factors of VTE can be further classified into modifiable, non-modifiable and temporary.


===Modifiable Risk Factors===
===Modifiable Risk Factors===
Modifiable risk factors are reversible based upon lifestyle/behavior modification.
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.<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252  }} </ref> <ref name="pmid21352080">{{cite journal| author=Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D| title=The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population. | journal=Metab Syndr Relat Disord | year= 2011 | volume= 9 | issue= 3 | pages= 197-201 | pmid=21352080 | doi=10.1089/met.2010.0117 | pmc= | url= }} </ref> <ref name="pmid18695082">{{cite journal| author=Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O et al.| title=Overweight, obesity, and the risk of recurrent venous thromboembolism. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 15 | pages= 1678-83 | pmid=18695082 | doi=10.1001/archinte.168.15.1678 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18695082  }} </ref>
* [[Obesity]]: [[Obesity]] is defined as a [[body-mass index]] (BMI) above 30 kg/m2.<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252  }} </ref> <ref name="pmid21352080">{{cite journal| author=Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D| title=The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population. | journal=Metab Syndr Relat Disord | year= 2011 | volume= 9 | issue= 3 | pages= 197-201 | pmid=21352080 | doi=10.1089/met.2010.0117 | pmc= | url= }} </ref> <ref name="pmid18695082">{{cite journal| author=Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O et al.| title=Overweight, obesity, and the risk of recurrent venous thromboembolism. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 15 | pages= 1678-83 | pmid=18695082 | doi=10.1001/archinte.168.15.1678 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18695082  }} </ref>
** Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252  }} </ref>
 
*** [[Smoking]]
* [[Smoking]]:<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252  }} </ref> [[Smoking]] significantly increases the risk of [[DVT]], particularly among women who are taking [[oral contraceptive pills]] as well as among [[obese]] people.
*** 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. <ref>http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm</ref>
* Use of [[oral contraceptives]]<ref name="pmid17726684">{{cite journal| author=Pomp ER, Rosendaal FR, Doggen CJ| title=Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. | journal=Am J Hematol | year= 2008 | volume= 83 | issue= 2 | pages= 97-102 | pmid=17726684 | doi=10.1002/ajh.21059 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17726684  }} </ref>
* '''Homocysteine:''' Elevated [[homocysteine]] has been reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.<ref name="pmid17024599">{{cite journal| author=Cattaneo M| title=Hyperhomocysteinemia and venous thromboembolism. | journal=Semin Thromb Hemost | year= 2006 | volume= 32 | issue= 7 | pages= 716-23 | pmid=17024599 | doi=10.1055/s-2006-951456 | pmc= | url= }} </ref>
 
* '''Smoking:''' Significantly increases the risk of [[DVT]], particularly in women who are taking [[oral contraceptive pills]].
* [[Hyperhomocysteinemia]]:<ref name="pmid8592549">{{cite journal| author=den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH et al.| title=Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 12 | pages= 759-62 | pmid=8592549 | doi=10.1056/NEJM199603213341203 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8592549  }} </ref> [[Hyperhomocysteinemia]] can be reduced with [[vitamin B]] supplementation.


===Non-Modifiable Risk Factors===
===Non-Modifiable Risk Factors===
* '''Age:''' The risk of DVT increases with age.
* Advanced age
* [[Heart failure]]
* [[Heart failure]]
* [[Thrombophilia]] or [[hypercoagulable state]]
* [[Thrombophilia]] or [[hypercoagulable state]]
** [[Factor V Leiden]]
** [[Prothrombin G20210A mutation]]
** [[Protein C deficiency]]
** [[Protein S deficiency]]
** [[Antithrombin deficiency]]
** [[Activated protein C resistance]]
** [[Antithrombin III deficiency]]
** [[Factor VIII]] [[mutation]]
** [[Antiphospholipid syndrome]]
** [[Heparin induced thrombocytopenia]]
** [[Nephrotic syndrome]]
** [[Paroxysmal nocturnal hemoglobinuria]]
* [[Polycythemia vera]]
* [[Polycythemia vera]]


===Temporary Risk Factors===
===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.<ref name="pmid15210384">{{cite journal| author=Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al.| title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. | journal=Am J Med | year= 2004 | volume= 117 | issue= 1 | pages= 19-25 | pmid=15210384 | doi=10.1016/j.amjmed.2004.01.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15210384  }} </ref>
* Injury to a deep vein from surgery, a fracture, or other [[trauma]], especially a paralytic spinal cord injury. <ref name="pmid12814980">{{cite journal |author=Anderson FA, Spencer FA |title=Risk factors for venous thromboembolism |journal=Circulation |volume=107 |issue=23 Suppl 1 |pages=I9–16 |year=2003 |month=June |pmid=12814980 |doi=10.1161/01.CIR.0000078469.07362.E6 |url=}}</ref>
* 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
* [[Pregnancy]] and the peri-partum period
* Active [[cancer]]
* Active [[cancer]]
* [[Central venous catheter]]
* [[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]].<ref name="pmid7752753">{{cite journal |author=Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D'Ovidio R, Cogo A, Prandoni P |title=Accuracy of clinical assessment of deep-vein thrombosis |journal=[[Lancet]] |volume=345 |issue=8961 |pages=1326–30 |year=1995|month=May |pmid=7752753 |doi= |url= |accessdate=2012-04-26}}</ref><ref name="pmid9867786">{{cite journal |author=Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Use of a clinical model for safe management of patients with suspected pulmonary embolism |journal=Ann Intern Med |volume=129 |issue=12 |pages=997-1005 |year=1998|pmid=9867786}}</ref><ref name="pmid10744147">{{cite journal | author = 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 | title = Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. | journal = Thromb Haemost | volume = 83 | issue = 3 | pages = 416-20 | year = 2000 | id = PMID 10744147}}</ref><ref name="pmid11453709">{{cite journal |author=Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ |title=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 |journal=Ann Intern Med |volume=135 |issue=2 |pages=98-107 |year=2001|pmid=11453709 | url=http://www.annals.org/cgi/content/full/135/2/98}}</ref>
'''[[Wells score calculator|Wells Score Calculator for PE]]'''


{| class=wikitable border=1
===Other Possible Risk Factors===
!Variable
Other possible factors associated with [[VTE]] include:
!Wells<ref name="pmid10744147">{{cite journal |author=Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer |journal=Thromb. Haemost. |volume=83 |issue=3 |pages=416–20 |year=2000 |month=March |pmid=10744147 |doi=|url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th00030416&no_cache=1 |accessdate=2012-05-01}}</ref>
* [[Nutrition]] low in fish, fruits, and vegetables<ref name="pmid17179018">{{cite journal| author=Steffen LM, Folsom AR, Cushman M, Jacobs DR, Rosamond WD| title=Greater fish, fruit, and vegetable intakes are related to lower incidence of [[venous thromboembolism]]: the Longitudinal Investigation of Thromboembolism Etiology. | journal=Circulation | year= 2007 | volume= 115 | issue= 2 | pages= 188-95 | pmid=17179018 | doi=10.1161/CIRCULATIONAHA.106.641688 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17179018  }} </ref>
|-
* [[Psychological stress]]<ref name="pmid18045241">{{cite journal| author=Rosengren A, Fredén M, Hansson PO, Wilhelmsen L, Wedel H, Eriksson H| title=Psychosocial factors and [[venous thromboembolism]]: a long-term follow-up study of Swedish men. | journal=J Thromb Haemost | year= 2008 | volume= 6 | issue= 4 | pages= 558-64 | pmid=18045241 | doi=10.1111/j.1538-7836.2007.02857.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18045241  }} </ref>
|Clinically suspected [[DVT]] (leg swelling, pain with palpation)
* [[Cardiovascular]] risk factors such as [[diabetes]] and [[hypercholesterolemia]]<ref name="pmid18086925">{{cite journal| author=Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW| title=Cardiovascular risk factors and venous thromboembolism: a meta-analysis. | journal=Circulation | year= 2008 | volume= 117 | issue= 1 | pages= 93-102 | pmid=18086925 | doi=10.1161/CIRCULATIONAHA.107.709204 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18086925  }} </ref>
|style="text-align:center"|3.0
* [[Acute]] medical illness
|-
* [[Drug abuse]] ([[intravenous]] drugs)<ref name="pmid11260066">{{cite journal| author=McColl MD, Tait RC, Greer IA, Walker ID| title=Injecting drug use is a risk factor for [[deep vein thrombosis]] in women in Glasgow. | journal=Br J Haematol | year= 2001 | volume= 112 | issue= 3 | pages= 641-3 | pmid=11260066 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260066  }} </ref>
|Alternative diagnosis is less likely than PE
*[[Sickle cell disease]]<ref name="pmid23582935">{{cite journal| author=Naik RP, Streiff MB, Haywood C, Nelson JA, Lanzkron S| title=Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication. | journal=Am J Med | year= 2013 | volume= 126 | issue= 5 | pages= 443-9 | pmid=23582935 | doi=10.1016/j.amjmed.2012.12.016 | pmc=PMC3627211 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23582935  }} </ref>
|style="text-align:center"|3.0
*[[Inflammatory bowel disease]]<ref name="pmid23629820">{{cite journal| author=Koutroumpakis EI, Tsiolakidou G, Koutroubakis IE| title=Risk of venous thromboembolism in patients with inflammatory bowel disease. | journal=Semin Thromb Hemost | year= 2013 | volume= 39 | issue= 5 | pages= 461-8 | pmid=23629820 | doi=10.1055/s-0033-1343886 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23629820  }} </ref>
|-
*[[Antipsychotic drugs]]<ref name="pmid22731933">{{cite journal| author=Jönsson AK, Spigset O, Hägg S| title=Venous thromboembolism in recipients of antipsychotics: incidence, mechanisms and management. | journal=CNS Drugs | year= 2012 | volume= 26 | issue= 8 | pages= 649-62 | pmid=22731933 | doi=10.2165/11633920-000000000-00000 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22731933  }} </ref>
|Immobilization/[[surgery]] in previous four weeks
*[[Thrombocytosis]]<ref name="pmid22784217">{{cite journal| author=Ho KM, Yip CB, Duff O| title=Reactive thrombocytosis and risk of subsequent venous thromboembolism: a cohort study. | journal=J Thromb Haemost | year= 2012 | volume= 10 | issue= 9 | pages= 1768-74 | pmid=22784217 | doi=10.1111/j.1538-7836.2012.04846.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22784217  }} </ref>
|style="text-align:center"|1.5
*[[Varicose veins]]<ref name="pmid22915533">{{cite journal| author=Müller-Bühl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G| title=Varicose veins are a risk factor for deep venous thrombosis in general practice patients. | journal=Vasa | year= 2012 | volume= 41 | issue= 5 | pages= 360-5 | pmid=22915533 | doi=10.1024/0301-1526/a000222 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22915533  }} </ref><ref name="pmid24112869">{{cite journal| author=Königsbrügge O, Lötsch F, Reitter EM, Brodowicz T, Zielinski C, Pabinger I et al.| title=Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism. | journal=J Thromb Haemost | year= 2013 | volume= 11 | issue= 11 | pages= 1993-2000 | pmid=24112869 | doi=10.1111/jth.12408 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24112869  }} </ref>
|-
|Previous history of [[DVT]] or [[PE]]
|style="text-align:center"|1.5
|-
|[[Tachycardia]] (heart rate more than 100 bpm)
|style="text-align:center"|1.5
|-
|[[Malignancy]] (treatment for within 6 months, palliative)
|style="text-align:center"|1.0
|-
|[[Hemoptysis]]
|style="text-align:center"|1.0
|-
|}


====Wells Criteria <ref name="pmid10744147"/><ref name="pmid11453709"/>====
[[File:.r.png|left|thumb|400px|Courtesy CDC]]
* The following scoring system is used for assessment of risk<ref name="pmid17185658">{{cite journal |author=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 |title=Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators |journal=Radiology |volume=242 |issue=1 |pages=15-21 |year=2007 |doi=10.1148/radiol.2421060971 | pmid=17185658}}</ref> and need for further testing with [[Pulmonary embolism D-dimer|D-dimer]] or [[Pulmonary embolism CT|CT]] scan:


** Score > 6.0 - High probability (~59%).
<br style="clear:left" />
** Score 2.0 to 6.0 - Moderate probability (~29%).
** Score < 2.0 - Low probability (~15%).


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


[[Category:Disease]]
[[Category:Disease]]

Latest revision as of 17:06, 7 March 2018
Resident
Survival
Guide

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; Rim Halaby, M.D. [3]

Deep Vein Thrombosis Microchapters

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Overview

Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. In these chapters on VTE, the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing venous thrombosis. The word triggers refer to those factors in the patients immediate history or environment that may have led to the occurrence of the venous thrombosis. The risk factors for VTE are a constellation of predisposing conditions which stem from the three principles of Virchow's triad: stasis of the blood flow, damage to the vascular endothelial cells, and hypercoagulability. The risk factors for VTE can be classified as temporary, modifiable and non-modifiable. It is suggested that venous thrombosis also shares risk factors with arterial thrombosis, such as obesity, hypertension, smoking, and diabetes mellitus.[1]

Risk Factors

Shown below is a list of predisposing factors to VTE.[2][3] The risk factors are classified as moderate or weak depending on how strongly they predispose for a VTE.

Moderate risk factors Weak risk factors

❑ Chemotherapy
❑ Chronic heart failure
❑ Respiratory failure
❑ Hormone replacement therapy
❑ Cancer
❑ Oral contraceptive pills
❑ Stroke
❑ Pregnancy
❑ Postpartum
❑ Prior history of VTE
❑ Thrombophilia

❑ Advanced age

❑ Laparoscopic surgery
❑ Prepartum
❑ Obesity
❑ Varicose veins


The risk factors of VTE can be further classified into modifiable, non-modifiable and temporary.

Modifiable Risk Factors

Modifiable risk factors are reversible based upon lifestyle/behavior modification.

Non-Modifiable Risk Factors

Temporary Risk Factors


Other Possible Risk Factors

Other possible factors associated with VTE include:

Courtesy CDC


References

  1. ↑ Goldhaber SZ (2010). "Risk factors for venous thromboembolism". J Am Coll Cardiol. 56 (1): 1–7. doi:10.1016/j.jacc.2010.01.057. PMID 20620709.
  2. ↑ Anderson FA, Spencer FA (2003). "Risk factors for venous thromboembolism". Circulation. 107 (23 Suppl 1): I9–16. doi:10.1161/01.CIR.0000078469.07362.E6. PMID 12814980.
  3. ↑ Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.
  4. ↑ 4.0 4.1 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Pomp ER, Rosendaal FR, Doggen CJ (2008). "Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use". Am J Hematol. 83 (2): 97–102. doi:10.1002/ajh.21059. PMID 17726684.
  8. ↑ den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH; et al. (1996). "Hyperhomocysteinemia as a risk factor for deep-vein thrombosis". N Engl J Med. 334 (12): 759–62. doi:10.1056/NEJM199603213341203. PMID 8592549.
  9. ↑ Steffen LM, Folsom AR, Cushman M, Jacobs DR, Rosamond WD (2007). "Greater fish, fruit, and vegetable intakes are related to lower incidence of [[venous thromboembolism]]: the Longitudinal Investigation of Thromboembolism Etiology". Circulation. 115 (2): 188–95. doi:10.1161/CIRCULATIONAHA.106.641688. PMID 17179018. URL–wikilink conflict (help)
  10. ↑ Rosengren A, Fredén M, Hansson PO, Wilhelmsen L, Wedel H, Eriksson H (2008). "Psychosocial factors and [[venous thromboembolism]]: a long-term follow-up study of Swedish men". J Thromb Haemost. 6 (4): 558–64. doi:10.1111/j.1538-7836.2007.02857.x. PMID 18045241. URL–wikilink conflict (help)
  11. ↑ Ageno W, Becattini C, Brighton T, Selby R, Kamphuisen PW (2008). "Cardiovascular risk factors and venous thromboembolism: a meta-analysis". Circulation. 117 (1): 93–102. doi:10.1161/CIRCULATIONAHA.107.709204. PMID 18086925.
  12. ↑ McColl MD, Tait RC, Greer IA, Walker ID (2001). "Injecting drug use is a risk factor for [[deep vein thrombosis]] in women in Glasgow". Br J Haematol. 112 (3): 641–3. PMID 11260066. URL–wikilink conflict (help)
  13. ↑ Naik RP, Streiff MB, Haywood C, Nelson JA, Lanzkron S (2013). "Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication". Am J Med. 126 (5): 443–9. doi:10.1016/j.amjmed.2012.12.016. PMC 3627211. PMID 23582935.
  14. ↑ Koutroumpakis EI, Tsiolakidou G, Koutroubakis IE (2013). "Risk of venous thromboembolism in patients with inflammatory bowel disease". Semin Thromb Hemost. 39 (5): 461–8. doi:10.1055/s-0033-1343886. PMID 23629820.
  15. ↑ Jönsson AK, Spigset O, Hägg S (2012). "Venous thromboembolism in recipients of antipsychotics: incidence, mechanisms and management". CNS Drugs. 26 (8): 649–62. doi:10.2165/11633920-000000000-00000. PMID 22731933.
  16. ↑ Ho KM, Yip CB, Duff O (2012). "Reactive thrombocytosis and risk of subsequent venous thromboembolism: a cohort study". J Thromb Haemost. 10 (9): 1768–74. doi:10.1111/j.1538-7836.2012.04846.x. PMID 22784217.
  17. ↑ Müller-Bühl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G (2012). "Varicose veins are a risk factor for deep venous thrombosis in general practice patients". Vasa. 41 (5): 360–5. doi:10.1024/0301-1526/a000222. PMID 22915533.
  18. ↑ Königsbrügge O, Lötsch F, Reitter EM, Brodowicz T, Zielinski C, Pabinger I; et al. (2013). "Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism". J Thromb Haemost. 11 (11): 1993–2000. doi:10.1111/jth.12408. PMID 24112869.

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