Deep vein thrombosis risk factors

Resident Survival Guide

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] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet; Rim Halaby, M.D. [3]

Deep Vein Thrombosis Microchapters
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Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Deep vein thrombosis from other Diseases
Epidemiology and Demographics
Risk Factors
Triggers
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
Assessment of Clinical Probability and Risk Scores
Assessment of Probability of Subsequent VTE and Risk Scores
History and Symptoms
Physical Examination
Laboratory Findings
Ultrasound
Venography
CT
MRI
Other Imaging Findings
Treatment
Treatment Approach
Medical Therapy
IVC Filter
Invasive Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Special Scenario
Upper extremity DVT
Recurrence
Pregnancy
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Landmark Trials
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Overview

Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. In these chapters on VTE, the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing venous thrombosis. The word triggers refer to those factors in the patients immediate history or environment that may have led to the occurrence of the venous thrombosis. The risk factors for VTE are a constellation of predisposing conditions which stem from the three principles of Virchow's triad: stasis of the blood flow, damage to the vascular endothelial cells, and hypercoagulability. The risk factors for VTE can be classified as temporary, modifiable and non-modifiable. It is suggested that venous thrombosis also shares risk factors with arterial thrombosis, such as obesity, hypertension, smoking, and diabetes mellitus.

Risk Factors

Shown below is a list of predisposing factors to VTE. The risk factors are classified as moderate or weak depending on how strongly they predispose for a VTE.

Moderate risk factors	Weak risk factors
❑ Chemotherapy ❑ Chronic heart failure ❑ Respiratory failure ❑ Hormone replacement therapy ❑ Cancer ❑ Oral contraceptive pills ❑ Stroke ❑ Pregnancy ❑ Postpartum ❑ Prior history of VTE ❑ Thrombophilia	❑ Advanced age ❑ Laparoscopic surgery ❑ Prepartum ❑ Obesity ❑ Varicose veins

Risk factors of VTE

Modifiable Risk Factors	Non-Modifiable Risk Factors	Temporary Risk Factors	Other Risk Factors
❑ Modifiable risk factors are reversible based upon lifestyle/behavior modification. ❑ Obesity is defined as a body-mass index (BMI) above 30 kg/m2. ❑ Smoking: Smoking significantly increases the risk of DVT, particularly among women who are taking oral contraceptive pills as well as among obese people. ❑ Use of oral contraceptives ❑ Hyperhomocysteinemia: Hyperhomocysteinemia can be reduced with vitamin B supplementation.	❑ Advanced age ❑ Heart failure ❑ Thrombophilia or hypercoagulable state ❑ Polycythemia vera ❑ Factor V Leiden ❑ Prothrombin G20210A mutation ❑ Protein C deficiency ❑ Protein S deficiency ❑ Activated protein C resistance ❑ Antithrombin III deficiency ❑ Factor VIII mutation ❑ Antiphospholipid syndrome ❑ Heparin induced thrombocytopenia ❑ Nephrotic syndrome ❑ Paroxysmal nocturnal hemoglobinuria	❑ Advanced age ❑ Pregnancy and the peri-partum period ❑ Active cancer ❑ Central venous catheter	❑ Advanced age ❑ Other possible factors associated with VTE include: ❑ Nutrition low in fish ❑ Psychological stress ❑ Cardiovascular risk factors such as diabetes and hypercholesterolemia