Thrombosis: Difference between revisions
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===Causes by Organ System=== | ===Causes by Organ System=== | ||
{|style="width:80%; height:100px" border="1" | {| style="width:80%; height:100px" border="1" | ||
| | | style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular''' | ||
| | | style="width:75%" bgcolor="Beige" ; border="1" | [[Antithrombin III deficiency]], [[aortic dissection]], [[arteritis]], [[atheroma]], [[atherosclerosis]], [[atrial fibrillation]], [[atrioventricular septal defect]], [[cholesterol embolization]], [[congestive heart failure]], [[coronary artery thrombus|coronary artery thrombosis]], [[deep vein thrombosis]], [[defibrination syndrome]], [[disseminated intravascular coagulation]], [[Eisenmenger syndrome]], [[lipoprotein(a)|elevated lipoprotein a]], [[hypercholesterolemia]], [[hyperlipidemia]], [[hypertension]], [[hypertriglyceridemia]], [[Kawasaki disease]], [[left ventricular failure]], [[mesenteric vein thrombosis|mesenteric venous thrombosis]], [[obesity]], [[Paget-Schroetter disease]], [[venous thrombosis|pelvic vein thrombosis]], [[peripheral vascular disease]], [[plasminogen|plasminogen deficiency type I]], [[plasminogen|plasminogen deficiency type II]], [[postphlebitic syndrome]], [[central venous catheter|presence of a central venous catheter]], [[stent]], [[stroke]], [[subclavian vein thrombosis]], [[thrombophlebitis|superficial thrombophlebitis]], [[superior vena cava syndrome]], [[vasculitis]] | ||
|- | |- | ||
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning''' | | bgcolor="LightSteelBlue" | '''Chemical/Poisoning''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dental''' | | '''Dental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Dermatologic''' | | '''Dermatologic''' | ||
|bgcolor="Beige"| [[Behcet's disease]], [[Klippel Trenaunay syndrome]], [[vasculitis]] | | bgcolor="Beige" | [[Behcet's disease]], [[Klippel Trenaunay syndrome]], [[vasculitis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''Drug Side Effect''' | ||
|bgcolor="Beige"|[[Aflibercept]], [[Asparaginase Erwinia chrysanthemi]], [[asparaginase]], [[chemotherapy]], [[coagulation factor IX]], [[coagulation factor XIII A-subunit]], [[conestat alfa]], [[desmopressin]], [[elspar]], [[eltrombopag]], [[estramustine]], [[estrogen replacement therapy]], [[ethynodiol diacetate and ethinyl estradiol]], [[femara]], [[glucocorticoids]], [[hormone replacement therapy]], [[iodixanol]], [[lenalidomide]], [[letrozole]], [[L-asparaginase|leunase]], [[meclofenamate]], [[oral contraceptives]], [[pegaspargase]], [[rapamune]], [[romiplostim]],[[sirolimus]], [[tamoxifen]], [[thalidomide]], [[tromethamine]] | | bgcolor="Beige" |[[Aflibercept]], [[Asparaginase Erwinia chrysanthemi]], [[asparaginase]], [[chemotherapy]], [[coagulation factor IX]], [[coagulation factor XIII A-subunit]], [[conestat alfa]], [[desmopressin]], [[elspar]], [[eltrombopag]], [[estramustine]], [[estrogen replacement therapy]], [[ethynodiol diacetate and ethinyl estradiol]], [[femara]], [[glucocorticoids]], [[hormone replacement therapy]], [[iodixanol]], [[lenalidomide]], [[letrozole]], [[L-asparaginase|leunase]], [[meclofenamate]], [[oral contraceptives]], [[pegaspargase]], [[rapamune]], [[romiplostim]],[[sirolimus]], [[tamoxifen]], [[thalidomide]], [[tromethamine]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Ear Nose Throat''' | | '''Ear Nose Throat''' | ||
|bgcolor="Beige"|[[Mastoiditis]], [[superior vena cava syndrome]] | | bgcolor="Beige" |[[Mastoiditis]], [[superior vena cava syndrome]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"|[[Diabetes mellitus]], [[obesity]] | | bgcolor="Beige" |[[Diabetes mellitus]], [[obesity]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Environmental''' | | '''Environmental''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Gastroenterologic''' | | '''Gastroenterologic''' | ||
|bgcolor="Beige"| [[Budd-Chiari syndrome]], [[chronic pancreatitis]], [[hemorrhoids]], [[hepatic vein thrombosis]], [[inflammatory bowel disease]], [[liver cirrhosis]], [[liver disease]], [[mucormycosis]], [[obesity]], [[pancreatic cancer]], [[zygomycosis]] | | bgcolor="Beige" | [[Budd-Chiari syndrome]], [[chronic pancreatitis]], [[hemorrhoids]], [[hepatic vein thrombosis]], [[inflammatory bowel disease]], [[liver cirrhosis]], [[liver disease]], [[mucormycosis]], [[obesity]], [[pancreatic cancer]], [[zygomycosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Genetic''' | | '''Genetic''' | ||
|bgcolor="Beige"| [[familial dysfibrinogenemia|Ales dysfibrinogenemia]], [[fibronectin|elevated plasma fibronectin levels]], [[factor V Leiden mutation]], [[Marchiafava-Micheli disease]], [[paroxysmal nocturnal hemoglobinuria]] | | bgcolor="Beige" | [[familial dysfibrinogenemia|Ales dysfibrinogenemia]], [[fibronectin|elevated plasma fibronectin levels]], [[factor V Leiden mutation]], [[Marchiafava-Micheli disease]], [[paroxysmal nocturnal hemoglobinuria]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Hematologic''' | | '''Hematologic''' | ||
|bgcolor="Beige"| [[familial dysfibrinogenemia|Ales dysfibrinogenemia]], [[antiphospholipid syndrome]], [[antithrombin III deficiency]], [[cavernous sinus thrombosis]], [[heparin cofactor II|decreased heparin cofactor II]], [[thrombomodulin|decreased thrombomodulin]], [[tissue factor pathway inhibitor|decreased tissue factor pathway inhibitor (TFPI)]], [[tissue plasminogen activator|decreased tissue plasminogen activator deficiency]], [[deep vein thrombosis]], [[defibrination syndrome]], [[disseminated intravascular coagulation]], [[familial dysfibrinogenemia|dysfibrinogenemia]], [[fibrinogen|elevated fibrinogen]], [[fibronectin|elevated plasma fibronectin levels]], [[thrombin-activatable fibrinolysis inhibitor|elevated thrombin-activatable fibrinolysis inhibitor (TAFI)]], [[essential thrombocythemia]], [[factor XII|factor XII deficiency]], [[heparin-induced thrombocytopenia]], [[hypercoagulability|hypercoagulability syndrome]], [[hyperviscosity syndrome]], [[factor IX|increased factor IX]], [[factor VII|increased factor VII]], [[factor VIII|increased factor VIII]], [[factor XI|increased factor XI]], [[plasminogen activator inhibitor-1|increased plasminogen activator inhibitor-1 (PAI-1)]], [[Klippel Trenaunay syndrome]], [[hyperviscosity syndrome|leukostasis syndrome]], [[Marchiafava-Micheli disease]], [[multiple myeloma]], [[myeloproliferative disorders]], [[Osler-Vaquez disease]], [[Paget-Schroetter disease]], [[paroxysmal nocturnal hemoglobinuria]], [[venous thrombosis|pelvic vein thrombosis]], [[plasminogen|plasminogen deficiency type I]], [[plasminogen|plasminogen deficiency type II]], [[polycythemia vera]], [[polycythemia]], [[postphlebitic syndrome]], [[protein C deficiency]], [[protein S deficiency]], [[prothrombin gene mutation G20210A|prothrombin gene mutation]], [[sickle cell disease]], [[sticky platelet syndrome]], [[superior vena cava syndrome]], [[thrombophilia]], [[thrombotic microangiopathy]], [[Von Willebrand factor]], [[Waldenstrom macroglobulinemia]], [[familial dysfibrinogenemia|Wiesbaden dysfibrinogenemia]] | | bgcolor="Beige" | [[familial dysfibrinogenemia|Ales dysfibrinogenemia]], [[antiphospholipid syndrome]], [[antithrombin III deficiency]], [[cavernous sinus thrombosis]], [[heparin cofactor II|decreased heparin cofactor II]], [[thrombomodulin|decreased thrombomodulin]], [[tissue factor pathway inhibitor|decreased tissue factor pathway inhibitor (TFPI)]], [[tissue plasminogen activator|decreased tissue plasminogen activator deficiency]], [[deep vein thrombosis]], [[defibrination syndrome]], [[disseminated intravascular coagulation]], [[familial dysfibrinogenemia|dysfibrinogenemia]], [[fibrinogen|elevated fibrinogen]], [[fibronectin|elevated plasma fibronectin levels]], [[thrombin-activatable fibrinolysis inhibitor|elevated thrombin-activatable fibrinolysis inhibitor (TAFI)]], [[essential thrombocythemia]], [[factor XII|factor XII deficiency]], [[heparin-induced thrombocytopenia]], [[hypercoagulability|hypercoagulability syndrome]], [[hyperviscosity syndrome]], [[factor IX|increased factor IX]], [[factor VII|increased factor VII]], [[factor VIII|increased factor VIII]], [[factor XI|increased factor XI]], [[plasminogen activator inhibitor-1|increased plasminogen activator inhibitor-1 (PAI-1)]], [[Klippel Trenaunay syndrome]], [[hyperviscosity syndrome|leukostasis syndrome]], [[Marchiafava-Micheli disease]], [[multiple myeloma]], [[myeloproliferative disorders]], [[Osler-Vaquez disease]], [[Paget-Schroetter disease]], [[paroxysmal nocturnal hemoglobinuria]], [[venous thrombosis|pelvic vein thrombosis]], [[plasminogen|plasminogen deficiency type I]], [[plasminogen|plasminogen deficiency type II]], [[polycythemia vera]], [[polycythemia]], [[postphlebitic syndrome]], [[protein C deficiency]], [[protein S deficiency]], [[prothrombin gene mutation G20210A|prothrombin gene mutation]], [[sickle cell disease]], [[sticky platelet syndrome]], [[superior vena cava syndrome]], [[thrombophilia]], [[thrombotic microangiopathy]], [[Von Willebrand factor]], [[Waldenstrom macroglobulinemia]], [[familial dysfibrinogenemia|Wiesbaden dysfibrinogenemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Iatrogenic''' | | '''Iatrogenic''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| [[Mastoiditis]], [[meningococcal meningitis]], [[mucormycosis]], [[nipah virus encephalitis]], [[sepsis]], [[zygomycosis]] | | bgcolor="Beige" | [[Mastoiditis]], [[meningococcal meningitis]], [[mucormycosis]], [[nipah virus encephalitis]], [[sepsis]], [[zygomycosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal/Orthopedic''' | | '''Musculoskeletal/Orthopedic''' | ||
|bgcolor="Beige"| [[Arthroscopy]], [[fracture]], [[hip replacement surgery|hip surgery]], [[immobility]], [[knee pain/swelling surgery|knee surgery]], [[Maffucci syndrome]], [[orthopedic surgery]] | | bgcolor="Beige" | [[Arthroscopy]], [[fracture]], [[hip replacement surgery|hip surgery]], [[immobility]], [[knee pain/swelling surgery|knee surgery]], [[Maffucci syndrome]], [[orthopedic surgery]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| [[Antiphospholipid syndrome]], [[cavernous sinus thrombosis]], [[cerebral venous sinus thrombosis]], [[idiopathic intracranial hypertension]], [[meningococcal meningitis]], [[nipah virus encephalitis]], [[stroke]], [[thoracic inlet|thoracic inlet syndrome]], [[thoracic outlet syndrome]] | | bgcolor="Beige" | [[Antiphospholipid syndrome]], [[cavernous sinus thrombosis]], [[cerebral venous sinus thrombosis]], [[idiopathic intracranial hypertension]], [[meningococcal meningitis]], [[nipah virus encephalitis]], [[stroke]], [[thoracic inlet|thoracic inlet syndrome]], [[thoracic outlet syndrome]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Nutritional/Metabolic''' | | '''Nutritional/Metabolic''' | ||
|bgcolor="Beige"| [[lipoprotein(a)|Elevated lipoprotein a]], [[glycosylphosphatidylinositol|glycosylphosphatidylinositol deficiency]], [[hyperhomocysteinemia|homocystinemia]], [[hyperhomocysteinemia]], [[hyperlipidemia]], [[hypertriglyceridemia]], [[obesity]] | | bgcolor="Beige" | [[lipoprotein(a)|Elevated lipoprotein a]], [[glycosylphosphatidylinositol|glycosylphosphatidylinositol deficiency]], [[hyperhomocysteinemia|homocystinemia]], [[hyperhomocysteinemia]], [[hyperlipidemia]], [[hypertriglyceridemia]], [[obesity]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Obstetric/Gynecologic''' | | '''Obstetric/Gynecologic''' | ||
|bgcolor="Beige"| [[Abruptio placentae]], [[antiphospholipid syndrome]], [[eclampsia]], [[leiomyoma]], [[pre-eclampsia]], [[pregnancy]] | | bgcolor="Beige" | [[Abruptio placentae]], [[antiphospholipid syndrome]], [[eclampsia]], [[leiomyoma]], [[pre-eclampsia]], [[pregnancy]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| [[Cancer]], [[leukemia]], [[Maffucci syndrome]], [[malignancy]], [[multiple myeloma]], [[myeloproliferative disorders]], [[Osler-Vaquez disease]], [[pancreatic cancer]], [[paraneoplastic syndrome]], [[polycythemia vera]], [[superior vena cava syndrome]], [[Waldenstrom macroglobulinemia]] | | bgcolor="Beige" | [[Cancer]], [[leukemia]], [[Maffucci syndrome]], [[malignancy]], [[multiple myeloma]], [[myeloproliferative disorders]], [[Osler-Vaquez disease]], [[pancreatic cancer]], [[paraneoplastic syndrome]], [[polycythemia vera]], [[superior vena cava syndrome]], [[Waldenstrom macroglobulinemia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Ophthalmologic''' | | '''Ophthalmologic''' | ||
|bgcolor="Beige"| [[central retinal artery|Retinal artery thrombosis]], [[central retinal vein occlusion|retinal vein thrombosis]] | | bgcolor="Beige" | [[central retinal artery|Retinal artery thrombosis]], [[central retinal vein occlusion|retinal vein thrombosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Overdose/Toxicity''' | | '''Overdose/Toxicity''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Psychiatric''' | | '''Psychiatric''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Pulmonary''' | | '''Pulmonary''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Renal/Electrolyte''' | | '''Renal/Electrolyte''' | ||
|bgcolor="Beige"| [[Acute kidney injury]], [[chronic renal disease]], [[nephrotic syndrome]], [[renal vein thrombosis]] | | bgcolor="Beige" | [[Acute kidney injury]], [[chronic renal disease]], [[nephrotic syndrome]], [[renal vein thrombosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Rheumatology/Immunology/Allergy''' | | '''Rheumatology/Immunology/Allergy''' | ||
|bgcolor="Beige"| [[Antiphospholipid syndrome]], [[Behcet's disease]], [[interleukin 8|elevated interleukin 8]], [[Klippel Trenaunay syndrome]], [[polyarteritis nodosa]], [[vasculitis]] | | bgcolor="Beige" | [[Antiphospholipid syndrome]], [[Behcet's disease]], [[interleukin 8|elevated interleukin 8]], [[Klippel Trenaunay syndrome]], [[polyarteritis nodosa]], [[vasculitis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Sexual''' | | '''Sexual''' | ||
|bgcolor="Beige"| No underlying causes | | bgcolor="Beige" | No underlying causes | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Trauma''' | | '''Trauma''' | ||
|bgcolor="Beige"|[[Trauma]] | | bgcolor="Beige" |[[Trauma]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Urologic''' | | '''Urologic''' | ||
|bgcolor="Beige"|[[Fournier gangrene]] | | bgcolor="Beige" |[[Fournier gangrene]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| [[General surgery]], [[high altitude]], [[radiation]], [[smoking]], [[varicose veins]] | | bgcolor="Beige" | [[General surgery]], [[high altitude]], [[radiation]], [[smoking]], [[varicose veins]] | ||
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|} | |} | ||
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*[[Zygomycosis]] | *[[Zygomycosis]] | ||
}} | }} | ||
==Risk Factors== | ==Risk Factors== | ||
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
==Related Chapters== | ==Related Chapters== |
Revision as of 16:43, 29 August 2018
Thrombosis Microchapters |
Site of Thrombosis |
---|
Differentiating Thrombosis from other Diseases |
Diagnosis |
Treatment |
Thrombosis On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
To view main article on venous thrombosis, click here
To view main article on arterial thrombosis, click here for myocardial thrombosis or here for ischemic stroke
Overview
Thrombosis is the formation of a thrombus (medical term for a clot) inside a blood vessel. This can dislodge from the site it was formed and can move along the flow of blood to distant places in the body. A piece of thrombus that is transported in this way is called an embolus (plural emboli). This process of formation an emboli, from a thrombus is called thromboembolism. The term was coined in 1848 by Rudolph Carl Virchow.
The most important sites of thrombosis formation, based on their frequency and clinical effect are coronary arteries and deep veins of the legs. Former, the most important site of arterial thrombosis and latter the most important site of venous thrombosis.
Pathophysiology
Rudolf Virchow noted several factors affecting the clot formation, which are as follows:
1) Alterations in blood flow (stasis): Blood flows throughout the circulatory system, without significantly stopping or slowing any where. In certain pathological conditions where the blood flow slows down or stops, it causes:
- Increase in platelet to endothelium contact
- Decrease the dilution of clotting factors
This increases the risk of clot formation and form microthrombi, which further grow and propagate.
2) Injury to the vascular endothelium: Intrinsic or secondary to external trauma (eg, catheterization) can cause intimal damage and stimulates clot formation. See Coagulation.
3) Alterations in the constitution of blood (hypercoagulability): It is the propensity to develop thrombosis due to an abnormality in the system of coagulation.
These three conditions are collectively known as Virchow's triad and lead to intravascular coagulation, forming a mass of red blood cells, leukocytes, and fibrin.
Shown below is a table depicting the elements of Virchow's triad and their modern counterparts.
Virchow's | Modern | Notes |
---|---|---|
Phenomena of interrupted blood-flow | "Stasis" or "venous stasis" | The first category, alterations in normal blood flow, refers to several situations. These include turbulence, stasis, mitral stenosis, and varicose veins. The equivalence of Virchow's version and the modern version has been disputed. |
Phenomena associated with irritation of the vessel and its vicinity | "Endothelial injury" or "vessel wall injury" | The second category, injuries and/or trauma to endothelium includes damage to the veins arising from shear stress or hypertension. |
Phenomena of blood-coagulation | "Hypercoagulability" | The last category, alterations in the constitution of blood, has numerous possible risk factors such as hyperviscosity, deficiency of antithrombin III, nephrotic syndrome, changes after severe trauma or burn, disseminated cancer, late pregnancy and delivery, race, age, whether the patient is a smoker, and obesity. All of these risk factors lead to hypercoagulability. |
Thrombus Formation
- Usually there is a balance between the coagulation and fibrinolysis systems in order to not having abnormal thrombosis in the body.
- Factors that increase the risk for a homeostatic imbalance include:
Immobilization
- An insult to homeostatic balance can expose the sub-endothelium and lead to the collection of various coagulation factors. Accumulation of coagulation factors can lead to the formation of a thrombus of red blood cells, leukocytes, and fibrin.
- A thrombus is characteristically found to first develop in the calf veins and progressively grow in the direction of blood flow (leading to the heart).
- An exceedingly extensive thrombosis in deep veins can extend well into the iliac veins or the inferior vena cava.
- Atherosclerosis is a miss balance between lipids and the hemostasis system which caused clot in arteries. By occluding the artery myocardial infarction, stroke could happen .
- Thrombosis can happen in both Bare Metal Stent (BMS) and Drug Eluting Stent (DES).
Factors that serve as nidus for development stent thrombosis are:
Delayed endothelialization.
Inflammatory response to the stent material.
Hypersensitivity reaction around the stent material in DES serving as nidus for ST.
- Pregnancy increases risk of having thrombosis in both veins and arteries because of hypercoagulate state .
- Acquired risk factors for thrombosis are:
Oral contraceptive use,
Advanced age
Surgery
Prolonged immobilization like hospitalization .
This video explains the process of thrombosis:
{{#ev:youtube|X_POCRsy7i4}}
Genetics
Genetic factors that play roles in causing thrombosis :
- Non-O blood groups
- Factor V Leiden mutation
- Prothrombin G20210A gene variants
- Polymorphisms in factors IX17 or XI
Gross Pathology
- Dull appearance.
- Zahn line from platelets and fibrin with layers of RBCs in pulmonary venous thromboembolism.
- Gross picture of thrombosis is different in live and dead person.
In live person it is gray and firm.
In dead person it is dark purple or yellow elastic called "chicken fat".
Microscopic Pathology
- lamination
- Zahn line
Classification
There are two distinct forms of thrombosis:
Venous Thrombosis
- Deep venous thrombosis (with or without pulmonary embolism; together classified as venous thromboembolism/VTE)
- Portal vein thrombosis
- Renal vein thrombosis
- hepatic vein thrombosis (Budd-Chiari syndrome)
- Paget-Schroetter disease
- Cerebral venous sinus thrombosis
- Thoracic outlet syndrome (the cause of most Subclavian vein thrombosis unrelated to trauma)
Arterial Thrombosis
Classification of Embolism Based on Direction of Blood Flow
If a bacterial infection is present at the site of thrombosis, the thrombus may break down, spreading particles of infected material throughout the circulatory system (pyemia, septic embolus) and setting up metastatic abscesses wherever they come to rest.
Without an infection, the thrombus may become detached and enter circulation as an embolus, finally lodging in and completely obstructing a blood vessel (an infarction). The effects of an infarction depend on where it occurs.
The pathway of the embolism can be one of three types:
- Anterograde
- Retrograde
- Paradoxical
In anterograde embolism, the movement of emboli is in the direction of blood flow. In retrograde embolism, however, the emboli move in opposition to the blood flow direction; this is usually significant only in blood vessels with low pressure (veins) or with emboli of high weight. In paradoxical embolism, also known as crossed embolism, an embolus from the veins crosses to the arterial blood system. This is generally found only with heart problems such as septal defects between the atria or ventricles.
Causes
Thrombosis is caused by abnormalities in one or more of the following (Virchow's triad): the composition of the blood (hypercoagulability or thrombophilia), quality of the vessel wall (endothelial cell injury), and/or nature of the blood flow (stasis, turbulence)
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
Causes in Alphabetical Order
Risk Factors
The following are the risk factors for thrombosis:
- Medical
- Familial
- Antithrombin III deficiency
- Protein C deficiency/Protein S deficiency
- APC resistance (Factor V Leiden)
- Dysfibrogenemia
- Hypoplasminogenemia
- Familial homocysteinemia
Natural History, Complications and Prognosis
Related Chapters
- Deep vein thrombosis
- Pulmonary embolism
- Anticoagulants
- Congestive heart failure and thrombosis
- Thrombolysis
- Thrombectomy
- ↑ Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Büller HR, Rosendaal FR (2007). "The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations". PLoS Med. 4 (9): e290. doi:10.1371/journal.pmed.0040290. PMC 1989755. PMID 17896862.
- ↑ Mammen EF (1999). "Sticky platelet syndrome". Semin Thromb Hemost. 25 (4): 361–5. doi:10.1055/s-2007-994939. PMID 10548069.