Venous thromboembolism: Difference between revisions
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{| style="cellpadding=0; cellspacing= 0; width: 600px;" | {| style="cellpadding=0; cellspacing= 0; width: 600px;" | ||
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| 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="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> | ❑ [[Chronic heart failure]]<br> | ||
❑ [[Respiratory failure]]<br> | ❑ [[Respiratory failure]]<br> | ||
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❑ Prior history of [[VTE]] <br> | ❑ Prior history of [[VTE]] <br> | ||
❑ [[Thrombophilia]] <br> | ❑ [[Thrombophilia]] <br> | ||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ Advanced [[age]] <br> | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |❑ Advanced [[age]] <br> | ||
❑ [[Laparoscopic surgery]] <br> | ❑ [[Laparoscopic surgery]] <br> | ||
❑ Prepartum <br> | ❑ Prepartum <br> | ||
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==Prevention== | ==Prevention== | ||
=== Risk Assessment === | |||
The following scoring systems can be used to assess the risk of VTE, based on risk factors: | |||
====Padua Prediction Score for VTE==== | |||
Shown below is a table depicting Padua predictive score for VTE among hospitalized medical patients. The interpretation of the score is as follows: | |||
*'''Score≥ 4: High risk for VTE''' | |||
*'''Score< 4: Low risk for VTE'''<ref name="pmid20738765">{{cite journal| author=Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M et al.| title=A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. | journal=J Thromb Haemost | year= 2010 | volume= 8 | issue= 11 | pages= 2450-7 | pmid=20738765 | doi=10.1111/j.1538-7836.2010.04044.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20738765 }}</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
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| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align="center" |'''Variable'''|| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align="center" |'''Score''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Active [[cancer]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |3 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Previous [[VTE]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |3 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Decreased mobility|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |3 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |[[Thrombophilia]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |3 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Previous trauma or surgery within that last month|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |2 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Age≥ 70|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |[[Heart failure|Heart]] and/or [[respiratory failure]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |[[Ischemic stroke]] or [[acute myocardial infarction]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |Acute rheumatologic disorder and/or acute infection|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |[[Obesity]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |[[Hormonal therapy]]|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align="left" |1 | |||
|} | |||
<references /> | <references /> |
Revision as of 15:55, 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 |
|
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 |
Risk factors of VTE may be categorized in to modifiable, non-modifiable, temporary and other risk factors.
Modifiable Risk Factors | Non-Modifiable Risk Factors | Temporary Risk Factors | Other Risk Factors |
❑ Modifiable risk factors are reversible based upon lifestyle/behavior modification. |
❑ Advanced age
|
❑ Advanced age ❑ Pregnancy and the peri-partum period |
❑ Advanced age ❑ Other possible factors associated with VTE include:[16]
|
Diagnosis
Treatment
Prevention
Risk Assessment
The following scoring systems can be used to assess the risk of VTE, based on risk factors:
Padua Prediction Score for VTE
Shown below is a table depicting Padua predictive score for VTE among hospitalized medical patients. The interpretation of the score is as follows:
- Score≥ 4: High risk for VTE
- Score< 4: Low risk for VTE[17]
Variable | Score |
Active cancer | 3 |
Previous VTE | 3 |
Decreased mobility | 3 |
Thrombophilia | 3 |
Previous trauma or surgery within that last month | 2 |
Age≥ 70 | 1 |
Heart and/or respiratory failure | 1 |
Ischemic stroke or acute myocardial infarction | 1 |
Acute rheumatologic disorder and/or acute infection | 1 |
Obesity | 1 |
Hormonal therapy | 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.
- ↑ 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.
- ↑ Konofal E, Lecendreux M, Cortese S (2010). "Sleep and ADHD". Sleep Med. 11 (7): 652–8. doi:10.1016/j.sleep.2010.02.012. PMID 20620109.
- ↑ Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M; et al. (2010). "A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score". J Thromb Haemost. 8 (11): 2450–7. doi:10.1111/j.1538-7836.2010.04044.x. PMID 20738765.