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* Deep vein thrombosis (DVT)
* Deep vein thrombosis (DVT)
* Pulmonary embolism (PE)
* Pulmonary embolism (PE)
The following table further classifies DVT and PE:<ref name="pmid9546569">{{cite journal |author=Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS |title=Does this patient have deep vein thrombosis? |journal=JAMA |volume=279 |issue=14 |pages=1094–9 |year=1998 |month=April |pmid=9546569 |doi= |url=}}</ref><ref name="pmid7752753">{{cite journal |author=Wells PS, Hirsh J, Anderson DR, ''et al.'' |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=}}</ref><ref name="pmid8257253">{{cite journal |author=Cogo A, Lensing AW, Prandoni P, Hirsh J |title=Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound |journal=Arch. Intern. Med. |volume=153 |issue=24 |pages=2777–80 |year=1993 |month=December |pmid=8257253 |doi= |url=}}</ref><ref name="pmid19718469">{{cite journal |author=Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I |title=Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study |journal=Thromb. Haemost. |volume=102 |issue=3 |pages=493–500 |year=2009 |month=September|pmid=19718469|doi=10.1160/TH09-01-0053 |url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th09-01-0053&no_cache=1|accessdate=2011-12-14}}</ref> Clinically, proximal vein thrombosis is considered severe, and it is more commonly associated with serious chronic diseases than distal DVT, such as:<ref name="pmid18718469">{{cite journal| author=Alberts JL, Hass CJ, Vitek JL, Okun MS| title=Are two leads always better than one: an emerging case for unilateral subthalamic deep brain stimulation in Parkinson's disease. | journal=Exp Neurol | year= 2008 | volume= 214 | issue= 1 | pages= 1-5 | pmid=18718469 | doi=10.1016/j.expneurol.2008.07.019 | pmc=PMC2888769 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18718469  }} </ref><ref name="pmid8257253">{{cite journal| author=Cogo A, Lensing AW, Prandoni P, Hirsh J| title=Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 24 | pages= 2777-80 | pmid=8257253 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8257253  }} </ref>
The following table further classifies DVT and PE:<ref name="pmid9546569">{{cite journal |author=Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS |title=Does this patient have deep vein thrombosis? |journal=JAMA |volume=279 |issue=14 |pages=1094–9 |year=1998 |month=April |pmid=9546569 |doi= |url=}}</ref><ref name="pmid7752753">{{cite journal |author=Wells PS, Hirsh J, Anderson DR, ''et al.'' |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=}}</ref><ref name="pmid8257253">{{cite journal |author=Cogo A, Lensing AW, Prandoni P, Hirsh J |title=Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound |journal=Arch. Intern. Med. |volume=153 |issue=24 |pages=2777–80 |year=1993 |month=December |pmid=8257253 |doi= |url=}}</ref><ref name="pmid19718469">{{cite journal |author=Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I |title=Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study |journal=Thromb. Haemost. |volume=102 |issue=3 |pages=493–500 |year=2009 |month=September|pmid=19718469|doi=10.1160/TH09-01-0053 |url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th09-01-0053&no_cache=1|accessdate=2011-12-14}}</ref><ref name="pmid8257253">{{cite journal| author=Cogo A, Lensing AW, Prandoni P, Hirsh J| title=Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 24 | pages= 2777-80 | pmid=8257253 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8257253  }} </ref>


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Revision as of 15:17, 12 October 2017

Venous thromboembolism Microchapters

Patient Information

Deep vein thrombosis
Pulmonary embolism

Overview

Classification

Epidemiology

Risk Factors

Diagnosis

Treatment

Deep Vein Thrombosis
Pulmonary Embolism

Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]:Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overiew

Classification

Venous thromboembolism (VTE) may be classified into:[1]

  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)

The following table further classifies DVT and PE:[2][3][4][5][4]

Classification of Venous thromboembolism
Clinical diagnosis Sub-classification Comments
Deep vein thrombosis Upper extremity
  • Uncommon and accounts for 1-5 % of all DVT
  • Most likely due to:
    • Central venous catheter
    • Cardiac pacemaker
    • Implantable cardioverter defibrillator
    • Effort thrombosis (Paget–Schroetter disease)
    • Cancer
Lower extremity
  • Proximal:
    • Popliteal veins
    • Femoral veins
    • Iliac veins
  • Isolated distal:
    • Calf veins (Peroneal, soleal, posterior tibial, gastrocnemial, soleal, gastrocnemial, peroneal, posterior tibial)
Pulmonary embolism (PE) Massive PE (High risk)
  • Sustained hypotension (systolic blood pressure <90 mm Hg), not due to arrhythmia, hypovolemia, sepsis, or left ventricular dysfunction, and either lasting for at least 15 minutes or necessitating the administration of inotropes

OR

  • Pulselessness

OR

  • Persistent profound bradycardia (heart rate < 40 bpm) plus findings of shock
Sub-massive PE (Intermediate risk PE)
  • Right ventricular dysfunction OR myocardial necrosis

AND

  • Absence of systemic hypotension (systolic blood pressure >90 mm Hg)
 Low risk PE

Epidemiology

Risk Factors

Shown below is a list of predisposing factors for VTE.[6][7] 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:

Diagnosis

Treatment

Prevention

  1. ↑ Moheimani F, Jackson DE (2011). "Venous thromboembolism: classification, risk factors, diagnosis, and management". ISRN Hematol. 2011: 124610. doi:10.5402/2011/124610. PMC 3196154. PMID 22084692.
  2. ↑ Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS (1998). "Does this patient have deep vein thrombosis?". JAMA. 279 (14): 1094–9. PMID 9546569. Unknown parameter |month= ignored (help)
  3. ↑ Wells PS, Hirsh J, Anderson DR; et al. (1995). "Accuracy of clinical assessment of deep-vein thrombosis". Lancet. 345 (8961): 1326–30. PMID 7752753. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 Cogo A, Lensing AW, Prandoni P, Hirsh J (1993). "Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound". Arch. Intern. Med. 153 (24): 2777–80. PMID 8257253. Unknown parameter |month= ignored (help)
  5. ↑ Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I (2009). "Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study". Thromb. Haemost. 102 (3): 493–500. doi:10.1160/TH09-01-0053. PMID 19718469. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 8.0 8.1 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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)
  14. ↑ 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)
  15. ↑ 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.
  16. ↑ 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)
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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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