Pulmonary embolism risk factors

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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]

Overview

The most common sources of pulmonary embolism are proximal leg deep venous thrombosis (DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk of pulmonary embolism, thus DVT and PE are together considered as VTE. Approximately 15% of patients with a DVT witll develop a pulmonary embolus. The conditions of DVT and pulmonary embolism are generally regarded as a continuum termed venous thromboembolism (VTE).

Risk Factors

The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.

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

Medical conditions included in the trid are:

Risk Factors Identified in the PIOPED Study[1] Independent risk factors identified in prospective investigation of pulmonary embolism diagnosis (PIOPED) include:

  • Immobilization, paresis, or paralysis
  • Surgery within the last 3 months, and stroke were also risk factors, but may also relate to immobility.
  • History of venous thromboembolism.
  • Malignancy, especially lung cancer; found in up to 17% of patients with an idiopathic deep vein thrombosis (DVT).
  • Current or past history of thrombophlebitis
  • Trauma to the lower extremities and pelvis during the past 3 months
  • Smoking
  • Central venous instrumentation within the past 3 months
  • Prior pulmonary embolism
  • Heart failure
  • Chronic obstructive pulmonary disease
  • Travel of 4 hours or more in the past month

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 35 fold.
  • Hyperhomocysteinemia increases the risk of a DVT by a factor of 3.
  • Hyperhomocysteinemia with Factor V increases the risk of a DVT by 10 fold.
  • 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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