Deep vein thrombosis risk factors: Difference between revisions
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::* [[Smoking]] | ::* [[Smoking]] | ||
::* Use of [[oral contraceptives]] | ::* Use of [[oral contraceptives]] | ||
::* Prolonged air travel: However, travel by air increased the risk to the same extent as travel by bus, train or car, suggesting that the increased risk of air travel is due primarily to prolonged immobility <ref>http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm</ref> | ::* Prolonged air travel: However, travel by air increased the risk to the same extent as travel by bus, train or car, suggesting that the increased risk of air travel is due primarily to prolonged immobility. <ref>http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm</ref> | ||
* '''Homocysteine:''' Elevated [[homocysteine]] has been 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 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]], particularly in women who are taking [[oral contraceptive pills]]. | * '''Smoking:''' significantly increased the risk of [[DVT]], particularly in women who are taking [[oral contraceptive pills]]. | ||
Revision as of 18:14, 16 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 identification and minimization of risk factors is important in the management of DVT. The duration of anticoagulation is guided by the presence of thrombophilic risk factors.
DVT risk factors can be divided into three broad groups:
- Modifiable
- Non-modifiable
- Temporary
Modifiable risk factors
Modifiable risk factors are reversible based upon 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
- Prolonged air travel: However, travel by air increased the risk to the same extent as travel by bus, train or car, suggesting that the increased risk of air travel is due primarily to prolonged immobility. [4]
- Homocysteine: Elevated homocysteine has been reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.[5]
- Smoking: significantly increased the risk of DVT, particularly in women who are taking oral contraceptive pills.
Non-modifiable risk factors
- Age: The risk of DVT increases with age.
- Heart failure
- Thrombophilia or hypercoagulable state
- Polycythemia vera
Temporary risk factors
- A previous history of DVT (this is the 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.[6]
- Injury to a deep vein from surgery, a fracture, or other trauma
- Prolonged Immobilization causes stasis in the deep veins which may occur after surgery, with prolonged bedrest, or prolonged seating during travel.
- Pregnancy and the peri-partum period
- Active cancer
- Central venous catheter
Wells Score
Wells score is a simple and most commonly used clinical risk prediction tool to evaluate the need for further testing in patients suspected to have deep vein thrombosis and pulmonary embolism.[7] and has undergo modifications since.[8][9][10]
| Variable | Wells[9] |
|---|---|
| Clinically suspected DVT (leg swelling, pain with palpation) | 3.0 |
| Alternative diagnosis is less likely than PE | 3.0 |
| Immobilization/surgery in previous four weeks | 1.5 |
| Previous history of DVT or PE | 1.5 |
| Tachycardia (heart rate more than 100 bpm) | 1.5 |
| Malignancy (treatment for within 6 months, palliative) | 1.0 |
| Hemoptysis | 1.0 |
Wells criteria [9][10]
- The following scoring system is used for assessment of risk[11] and need for further testing with D-dimer or CT scan:
- Score >6.0 - High probability (~59%).
- Score 2.0 to 6.0 - Moderate probability (~29%).
- Score <2.0 - Low probability (~15%).
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.
- ↑ http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
- ↑ 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.
- ↑ Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D'Ovidio R, Cogo A, Prandoni P (1995). "Accuracy of clinical assessment of deep-vein thrombosis". Lancet. 345 (8961): 1326–30. PMID 7752753. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (1998). "Use of a clinical model for safe management of patients with suspected pulmonary embolism". Ann Intern Med. 129 (12): 997–1005. PMID 9867786.
- ↑ 9.0 9.1 9.2 Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (2000). "Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer". Thromb Haemost. 83 (3): 416–20. PMID 10744147.
- ↑ 10.0 10.1 Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ (2001). "Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer". Ann Intern Med. 135 (2): 98–107. PMID 11453709.
- ↑ Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD (2007). "Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators". Radiology. 242 (1): 15–21. doi:10.1148/radiol.2421060971. PMID 17185658.