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CMEUser, Bureaucrats, nocaptcha, Administrators
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Rim Halaby (talk | contribs)
CMEUser, Bureaucrats, nocaptcha, Administrators
27,346 edits
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===Thrombophilia===
====Thrombophilia====
====Genetic Thrombophilia====
====Genetic Thrombophilia====
* [[Factor V Leiden]]
* [[Factor V Leiden]]
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* [[Nephrotic syndrome]]
* [[Nephrotic syndrome]]
* [[Paroxysmal nocturnal hemoglobinuria]]
* [[Paroxysmal nocturnal hemoglobinuria]]
===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.<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]]
*** Prolonged air travel: However, travel by air increases 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>
* '''Smoking:''' Significantly increases the risk of [[DVT]], particularly in women who are taking [[oral contraceptive pills]].
===Non-Modifiable Risk Factors===
* '''Advanced age'''
* [[Heart failure]]
* [[Thrombophilia]] or [[hypercoagulable state]]
* [[Polycythemia vera]]
===Temporary Risk Factors===
* Injury to a deep vein from surgery, a fracture, or other [[trauma]], especially a paralytic spinal cord injury <ref name="pmid12814980">{{cite journal |author=Anderson FA, Spencer FA |title=Risk factors for venous thromboembolism |journal=Circulation |volume=107 |issue=23 Suppl 1 |pages=I9–16 |year=2003 |month=June |pmid=12814980 |doi=10.1161/01.CIR.0000078469.07362.E6 |url=}}</ref>
* 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]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 19:02, 30 May 2014

Overview

Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. 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 categorized as temporary, modifiable and non-modifiable. Venous thrombosis also shares risk factors with cardiac thrombosis, such as obesity, hypertension and smoking.

Risk Factors

Shown below is a list of predisposing factors to VTE.[1][2]

Strong risk factors Moderate risk factors Weak risk factors
❑ Bone fracture (hip or leg)

❑ Hip replacement surgery
❑ Knee replacement surgery
❑ Major general surgery
❑ Significant trauma
❑ Spinal cord injury

 ❑ Athroscopic knee surgery

❑ Central venous lines
❑ Chemotherapy
❑ Chronic heart failure
❑ Respiratory failure
❑ Hormone replacement therapy
❑ Cancer
❑ Oral contraceptive pills
❑ Stroke
❑ Pregnancy
❑ Postpartum
❑ Prior history of VTE
❑ Thrombophilia

❑ Bed rest for more than 3 days

❑ Prolonged car or air travel
❑ Advanced age
❑ Laparoscopic surgery
❑ Prepartum
❑ Obesity
❑ Varicose veins

Thrombophilia

Genetic Thrombophilia

Acquired Thrombophilia

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.[3] [4] [5]
    • Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:[3]
      • Smoking
      • Use of oral contraceptives
      • Prolonged air travel: However, travel by air increases 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. [6]
  • Homocysteine: Elevated homocysteine has been reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.[7]
  • Smoking: Significantly increases the risk of DVT, particularly in women who are taking oral contraceptive pills.

Non-Modifiable Risk Factors

Temporary Risk Factors

  • Injury to a deep vein from surgery, a fracture, or other trauma, especially a paralytic spinal cord injury [1]
  • 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

References

  1. ↑ 1.0 1.1 Anderson FA, Spencer FA (2003). "Risk factors for venous thromboembolism". Circulation. 107 (23 Suppl 1): I9–16. doi:10.1161/01.CIR.0000078469.07362.E6. PMID 12814980.
  2. ↑ Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.
  3. ↑ 3.0 3.1 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
  7. ↑ Cattaneo M (2006). "Hyperhomocysteinemia and venous thromboembolism". Semin Thromb Hemost. 32 (7): 716–23. doi:10.1055/s-2006-951456. PMID 17024599.
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