Venous thromboembolism: Difference between revisions
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Revision as of 15:21, 12 October 2017
Venous thromboembolism Microchapters |
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][6][7][8]
Classification of Venous thromboembolism | |||
---|---|---|---|
Clinical diagnosis | Sub-classification | Comments | |
Deep vein thrombosis | Upper extremity |
| |
Lower extremity |
| ||
Pulmonary embolism (PE) | Massive PE (High risk) |
OR
OR
| |
Sub-massive PE (Intermediate risk PE) |
AND
| ||
Low risk PE | >10 mm diameter |
Epidemiology
Risk Factors
Shown below is a list of predisposing factors for VTE.[9][10] 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 |
❑ Advanced age ❑ Laparoscopic surgery |
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.
- Smoking:[11] 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[14]
- Hyperhomocysteinemia:[15] Hyperhomocysteinemia can be reduced with vitamin B supplementation.
Non-Modifiable Risk Factors
- Advanced age
- Heart failure
- 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
Temporary Risk Factors
- Pregnancy and the peri-partum period
- Active cancer
- Central venous catheter
Other Possible Risk Factors
Other possible factors associated with VTE include:
- Nutrition low in fish, fruits, and vegetables[16]
- Psychological stress[17]
- Cardiovascular risk factors such as diabetes and hypercholesterolemia[18]
- Acute medical illness
- Drug abuse (intravenous drugs)[19]
- Sickle cell disease[20]
- Inflammatory bowel disease[21]
- Antipsychotic drugs[22]
- Thrombocytosis[23]
- Varicose veins[24][25]
Diagnosis
Treatment
Prevention
- ↑ 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.
- ↑ 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) - ↑ 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) - ↑ 4.0 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) - ↑ 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) - ↑ Joffe HV, Kucher N, Tapson VF, Goldhaber SZ (2004). "Upper-extremity deep vein thrombosis: a prospective registry of 592 patients". Circulation. 110 (12): 1605–11. doi:10.1161/01.CIR.0000142289.94369.D7. PMID 15353493. Retrieved 2012-10-07. Unknown parameter
|month=
ignored (help) - ↑ Isma N, Svensson PJ, Gottsäter A, Lindblad B (2010). "Upper extremity deep venous thrombosis in the population-based Malmö thrombophilia study (MATS). Epidemiology, risk factors, recurrence risk, and mortality". Thromb Res. 125 (6): e335–8. doi:10.1016/j.thromres.2010.03.005. PMID 20406709.
- ↑ Muñoz FJ, Mismetti P, Poggio R, Valle R, Barrón M, Guil M; et al. (2008). "Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry". Chest. 133 (1): 143–8. doi:10.1378/chest.07-1432. PMID 17925416.
- ↑ 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.
- ↑ 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.
- ↑ 11.0 11.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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)
- ↑ 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)
- ↑ 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.
- ↑ 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)
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.