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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Diagnosis |
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Treatment |
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Overview
Thrombus formation typically begins in the calf veins and naturally progresses to the proximal veins and ultimately, breaks free from the site formation and travels to the pulmonary artery where it is called a pulmonary embolism. In many cases, patients with a thrombus can be 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.