Deep vein thrombosis risk factors: Difference between revisions
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==Overview== | ==Overview== | ||
The presence of a risk factor plays a major role in the management of DVT. An understanding of the risk factors for venous thrombosis is necessary in order to maximize the prevention of this disease in high risk individuals and groups of patients. | The presence of a risk factor plays a major role in the management of DVT. An understanding of the risk factors for venous thrombosis is necessary in order to maximize the prevention of this disease in high risk individuals and groups of patients. The duration of anticoagulation is decided based on the prevalence of various risk factors, as explained in [[Thrombophilia#Treatment|Thrombophilia]]. | ||
Risk factors for DVT can be sub-divided in various sections like | Risk factors for DVT can be sub-divided in various sections like | ||
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# Non-Modifiable | # Non-Modifiable | ||
# Temporary | # Temporary | ||
==Modifiable risk factors== | ==Modifiable risk factors== | ||
'''Obesity:''' Obesity is defined as a body-mass index (BMI) above 30 kg/m2. Underweight subjects have reduced risk while obese people have significant risk for DVT, and or PE.<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252 }} </ref> <ref name="pmid21352080">{{cite journal| author=Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D| title=The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population. | journal=Metab Syndr Relat Disord | year= 2011 | volume= 9 | issue= 3 | pages= 197-201 | pmid=21352080 | doi=10.1089/met.2010.0117 | pmc= | url= }} </ref> <ref name="pmid18695082">{{cite journal| author=Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O et al.| title=Overweight, obesity, and the risk of recurrent venous thromboembolism. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 15 | pages= 1678-83 | pmid=18695082 | doi=10.1001/archinte.168.15.1678 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18695082 }} </ref> | * '''Obesity:''' Obesity is defined as a body-mass index (BMI) above 30 kg/m2. Underweight subjects have reduced risk while obese people have significant risk for DVT, and or PE.<ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252 }} </ref> <ref name="pmid21352080">{{cite journal| author=Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D| title=The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population. | journal=Metab Syndr Relat Disord | year= 2011 | volume= 9 | issue= 3 | pages= 197-201 | pmid=21352080 | doi=10.1089/met.2010.0117 | pmc= | url= }} </ref> <ref name="pmid18695082">{{cite journal| author=Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O et al.| title=Overweight, obesity, and the risk of recurrent venous thromboembolism. | journal=Arch Intern Med | year= 2008 | volume= 168 | issue= 15 | pages= 1678-83 | pmid=18695082 | doi=10.1001/archinte.168.15.1678 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18695082 }} </ref In a number of high-risk settings such as Smoking <ref name="pmid20404252">{{cite journal| author=Holst AG, Jensen G, Prescott E| title=Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. | journal=Circulation | year= 2010 | volume= 121 | issue= 17 | pages= 1896-903 | pmid=20404252 | doi=10.1161/CIRCULATIONAHA.109.921460 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404252 }} </ref>, use of hormonal contraceptive, and long flights, obesity appears to be a contributing factor for increasing the risk of VTE. | ||
* '''Homocysteine''' Elevated homocysteine has been consistently reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation <ref name="pmid17024599">{{cite journal| author=Cattaneo M| title=Hyperhomocysteinemia and venous thromboembolism. | journal=Semin Thromb Hemost | year= 2006 | volume= 32 | issue= 7 | pages= 716-23 | pmid=17024599 | doi=10.1055/s-2006-951456 | pmc= | url= }} </ref> | |||
''' | * '''Smoking''' significantly increased the risk of [[DVT]] in women who are taking [[oral contraceptive pills]]. | ||
==Non-modifiable risk factors== | ==Non-modifiable risk factors== | ||
* Age: risk of DVT increases with age. | * Age: risk of DVT increases with age. | ||
* | * [[Thrombophilia]] | ||
==Temporary risk factors== | ==Temporary risk factors== | ||
* A previous history of DVT (most significant risk factor).Cushman et al noted a 28-day case-fatality rate of 9.4% after first-time DVT and 15.1% after first-time PE.<ref name="pmid15210384">{{cite journal| author=Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al.| title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. | journal=Am J Med | year= 2004 | volume= 117 | issue= 1 | pages= 19-25 | pmid=15210384 | doi=10.1016/j.amjmed.2004.01.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15210384 }} </ref> | * A previous history of DVT (most significant risk factor). Cushman et al. noted a 28-day case-fatality rate of 9.4% after first-time DVT and 15.1% after first-time PE.<ref name="pmid15210384">{{cite journal| author=Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P et al.| title=Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. | journal=Am J Med | year= 2004 | volume= 117 | issue= 1 | pages= 19-25 | pmid=15210384 | doi=10.1016/j.amjmed.2004.01.018 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15210384 }} </ref> | ||
* Injury to a deep vein from surgery, fractured bone, or other trauma. | * Injury to a deep vein from surgery, fractured bone, or other trauma. | ||
* Prolong Immobilization : | * Prolong Immobilization: Causes stasis in the deep veins. This may occur after surgery, if you're ill and in bed for a long time, or if you're on a long flight. | ||
* Pregnancy and | * Pregnancy and puerperium. | ||
* | * Active cancer. | ||
* | * Central venous catheter. | ||
==References== | ==References== | ||
Revision as of 14:05, 14 May 2012
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Overview
The presence of a risk factor plays a major role in the management of DVT. An understanding of the risk factors for venous thrombosis is necessary in order to maximize the prevention of this disease in high risk individuals and groups of patients. The duration of anticoagulation is decided based on the prevalence of various risk factors, as explained in Thrombophilia.
Risk factors for DVT can be sub-divided in various sections like
- Modifiable
- Non-Modifiable
- Temporary
Modifiable risk factors
- Obesity: Obesity is defined as a body-mass index (BMI) above 30 kg/m2. Underweight subjects have reduced risk while obese people have significant risk for DVT, and or PE.[1] [2] , use of hormonal contraceptive, and long flights, obesity appears to be a contributing factor for increasing the risk of VTE.
- Homocysteine Elevated homocysteine has been consistently reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation [3]
- Smoking significantly increased the risk of DVT in women who are taking oral contraceptive pills.
Non-modifiable risk factors
- Age: risk of DVT increases with age.
- Thrombophilia
Temporary risk factors
- A previous history of DVT (most significant risk factor). Cushman et al. noted a 28-day case-fatality rate of 9.4% after first-time DVT and 15.1% after first-time PE.[4]
- Injury to a deep vein from surgery, fractured bone, or other trauma.
- Prolong Immobilization: Causes stasis in the deep veins. This may occur after surgery, if you're ill and in bed for a long time, or if you're on a long flight.
- Pregnancy and puerperium.
- Active cancer.
- Central venous catheter.
References
- ↑ 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.
- ↑ Cattaneo M (2006). "Hyperhomocysteinemia and venous thromboembolism". Semin Thromb Hemost. 32 (7): 716–23. doi:10.1055/s-2006-951456. PMID 17024599.
- ↑ Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P; et al. (2004). "Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology". Am J Med. 117 (1): 19–25. doi:10.1016/j.amjmed.2004.01.018. PMID 15210384.