Deep vein thrombosis risk factors: Difference between revisions
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==Overview== | ==Overview== | ||
The presence of | The presence of preceding risk factors plays a major role in the management of DVT. Risk must be appropriately quantified and understood in order for prevention initiatives to be effective, especially as it relates to high risk individuals. The duration of [[anticoagulation]] hinges largely on the role of [[Thrombophilia#Treatment|thrombophilic risk factors]]. | ||
In general, DVT risk can be stratified into three divisions: | |||
* Modifiable | |||
* Non-modifiable | |||
* 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> | Modifiable risk factors can be defined as risk factors within the patient profile which are reversible based on lifestyle/behavior modification. | ||
* '''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> | |||
:* Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:<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> | |||
::* Smoking | |||
::* Use of oral contraceptives (in women) | |||
::* Extended air travel or air travel of a long duration | |||
* '''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> | * '''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]]. | * '''Smoking''' significantly increased the risk of [[DVT]] in women who are taking [[oral contraceptive pills]]. | ||
Revision as of 19:51, 14 June 2012
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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Overview
The presence of preceding risk factors plays a major role in the management of DVT. Risk must be appropriately quantified and understood in order for prevention initiatives to be effective, especially as it relates to high risk individuals. The duration of anticoagulation hinges largely on the role of thrombophilic risk factors.
In general, DVT risk can be stratified into three divisions:
- Modifiable
- Non-modifiable
- Temporary
Modifiable risk factors
Modifiable risk factors can be defined as risk factors within the patient profile which are reversible based on lifestyle/behavior modification.
- 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] [3]
- Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:[1]
- Smoking
- Use of oral contraceptives (in women)
- Extended air travel or air travel of a long duration
- Homocysteine Elevated homocysteine has been consistently reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.[4]
- 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.[5]
- 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
- ↑ 1.0 1.1 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.
- ↑ 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.