Deep vein thrombosis natural history, complications and prognosis
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] Ujjwal Rastogi, MBBS [3]; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep Vein Thrombosis Microchapters |
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Overview
Thrombus formation typically begins in the calf veins and naturally progresses to the proximal veins and ultimately, the pulmonary artery where it is called a pulmonary embolism. In most cases, patients with calf vein deep vein thrombosis present as asymptomatic.
Natural History
- Untreated proximal DVT
- Clinical PE occur in 1/3rd to 1/2 patients.
- Subclinical PE occurs in another 1/3rd.
- Untreated PE tends to recur in days to weeks.
- Post-phlebitic syndrome(10-30% of DVT)
- Pain, edema, skin discoloration, and ulceration associated with chronic venous insufficiency.
Death occurs in about 6 percent of DVT cases within one month of diagnosis. [1]
According to a study done on 826 patients in Medical University of Vienna the risk of recurrence was almost four times as great among men as among women.[2]
Complications
Proximal vein thrombosis is responsible for more than ninety percent of acute pulmonary embolism which has high mortality if not treated promptly. [3]
The major outcomes of venous thrombosis are
- Recurrence,
- Major bleeding due to anticoagulation,
- Death.
Other complications include:
- Post-thrombotic syndrome,
- Phlegmasia alba dolens,
- Phlegmasia cerulea dolens,
- Lemierre syndrome
- Septic pelvic thrombophlebitis
Thrombosis is also associated with impaired quality of life, particularly when post-thrombotic syndrome develops[4]. Death occurs within one month of an episode in about 6% of those with DVT and 10% of those with PE
References
- ↑ White RH (2003). "The epidemiology of venous thromboembolism". Circulation. 107 (23 Suppl 1): I4–8. doi:10.1161/01.CIR.0000078468.11849.66. PMID 12814979.
- ↑ Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S (2004). "The risk of recurrent venous thromboembolism in men and women". N Engl J Med. 350 (25): 2558–63. doi:10.1056/NEJMoa032959. PMID 15201412. Review in: ACP J Club. 2004 Nov-Dec;141(3):78
- ↑ 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) - ↑ Kahn SR, Ducruet T, Lamping DL, Arsenault L, Miron MJ, Roussin A; et al. (2005). "Prospective evaluation of health-related quality of life in patients with deep venous thrombosis". Arch Intern Med. 165 (10): 1173–8. doi:10.1001/archinte.165.10.1173. PMID 15911732.