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'''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org], {{ATI}}; {{AE}} {{CZ}}
'''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org], {{ATI}}; {{AE}} {{CZ}}
==Overview==
==Overview==
The most common sources of pulmonary emboli are proximal leg [[deep venous thrombosis|deep venous thromboses]] ([[DVT]]s) or pelvic vein thromboses. Any risk factor for [[DVT]] also increases the risk of pulmonary embolism, and therefore DVT and PE are considered to be a continuum termed [[venous thromboembolism]] ([[VTE]]). Approximately 15% of patients with a DVT will develop a pulmonary embolus.
The most common sources of pulmonary emboli are proximal leg [[deep venous thrombosis|deep venous thromboses]] ([[DVT]]s) or pelvic vein thromboses. Any risk factor for [[DVT]] also increases the risk of pulmonary embolism, and therefore DVT and PE are considered to be a continuum termed [[venous thromboembolism]] ([[VTE]]). Approximately 15% of patients with a DVT will develop a pulmonary embolus.  Smoking, oral contraceptives, and immobilization are common risk factors.


==Risk Factors==
==Risk Factors==

Revision as of 02:29, 30 October 2012

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Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The most common sources of pulmonary emboli are proximal leg deep venous thromboses (DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk of pulmonary embolism, and therefore DVT and PE are considered to be a continuum termed venous thromboembolism (VTE). Approximately 15% of patients with a DVT will develop a pulmonary embolus. Smoking, oral contraceptives, and immobilization are common risk factors.

Risk Factors

The development of thrombosis is classically due to a group of causes referred to as Virchow's triad. Virchow's triad includes alterations in blood flow, factors in the vessel wall, and factors affecting the properties of the blood. It is common for more than one risk factor to be present.

Figure: Virchow's triad encompasses three broad categories of factors that are thought to contribute to venous thrombosis.

Medical conditions included in the triad are:

Risk Factors Identified in the PIOPED Study[1]

Independent risk factors identified in prospective investigation of pulmonary embolism diagnosis (PIOPED) include:

Risk Factors from the Nurses' Health Study[2]

Risk Factors from the Physician's Health Study[3]

  • Anticardiolipin antibody level above the 95th percentile. [4].
  • Factor V Leiden
    • RR 2.7, found in 40% of patients with idiopathic DVT.
  • Use of oral contraceptives by a person with the Factor V mutation increases the risk of venous thromboembolism by about 35 times.
  • Hyperhomocysteinemia increases the risk of a DVT by a factor of 3.
  • Hyperhomocysteinemia in association with Factor V increases the risk of a DVT by about 10 times.
  • Lupus anticoagulant was found in 8.5% of patients with idiopathic DVT.

Other risk factors include:

References

  1. Worsley DF, Alavi A (1995). "Comprehensive analysis of the results of the PIOPED Study. Prospective Investigation of Pulmonary Embolism Diagnosis Study". J Nucl Med. 36 (12): 2380–7. PMID 8523135.
  2. Goldhaber SZ, Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Speizer FE; et al. (1997). "A prospective study of risk factors for pulmonary embolism in women". JAMA. 277 (8): 642–5. PMID 9039882.
  3. Ridker PM, Hennekens CH, Lindpaintner K, Stampfer MJ, Eisenberg PR, Miletich JP (1995). "Mutation in the gene coding for coagulation factor V and the risk of myocardial infarction, stroke, and venous thrombosis in apparently healthy men". N Engl J Med. 332 (14): 912–7. doi:10.1056/NEJM199504063321403. PMID 7877648.
  4. Ginsburg KS, Liang MH, Newcomer L, Goldhaber SZ, Schur PH, Hennekens CH; et al. (1992). "Anticardiolipin antibodies and the risk for ischemic stroke and venous thrombosis". Ann Intern Med. 117 (12): 997–1002. PMID 1443986.

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