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==Overview==
==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 [[Thrombophilia#Treatment|thrombophilic risk factors]].
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 cell]]s, 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 [[artery thrombosis]], such as [[obesity]], [[hypertension]], [[smoking]], and [[diabetes mellitus]].<ref name="pmid20620709">{{cite journal| author=Goldhaber SZ| title=Risk factors for venous thromboembolism. | journal=J Am Coll Cardiol | year= 2010 | volume= 56 | issue= 1 | pages= 1-7 | pmid=20620709 | doi=10.1016/j.jacc.2010.01.057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20620709  }} </ref>


==Risk Factors==
==Risk Factors==
Recently a research group<ref name="pmid21846713">{{cite journal| author=Hippisley-Cox J, Coupland C|title=Development
and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism:
prospective cohort study. | journal=BMJ | year= 2011 | volume= 343 | issue=  | pages= d4656 | pmid=21846713 | doi=10.1136/bmj.d4656
| pmc=PMC3156826 | url= }} </ref>. has postulated a risk-prediction algorithm for VTE. This algorith helps:
*Estimates individual risk for VTE
*To start prophylaxis in patients at risk for VTE.


This algorithm does not work in these conditions:
Shown below is a list of predisposing factors to [[VTE]].<ref name="pmid12814980">{{cite journal| author=Anderson FA, Spencer FA| title=Risk factors for venous thromboembolism. | journal=Circulation | year= 2003 | volume= 107 | issue= 23 Suppl 1 | pages= I9-16 | pmid=12814980 | doi=10.1161/01.CIR.0000078469.07362.E6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12814980  }} </ref><ref name="pmid18757870">{{cite journal| author=Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al.| title=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). | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 18 | pages= 2276-315 | pmid=18757870 | doi=10.1093/eurheartj/ehn310 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18757870  }} </ref> The risk factors are classified as strong, moderate and weak depending on how strongly they predispose for a VTE.
*History of venous thrombosis
*Family history of venous thrombosis.
*Pregnant patients
*Patients on [[Anticoagulation]]s
*Symptoms suggestive of [[thrombosis]].


The various variables that are taken into account are as follows
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
 
{|style="background:white" border="1"
|-
|Age
|-
|Body mass index
|-
|Smoking status (non-smoker; ex-smoker; light, moderate, or heavy smoker)
|-
|Townsend deprivation score
|-
|Varicose veins
|-
|-
|Congestive cardiac failure
| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Strong risk factors'''|| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Moderate risk factors''' || style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Weak risk factors'''
|-
|-
|Rheumatoid arthritis
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ [[Bone fracture]] ([[hip]] or [[leg]]) <br>
|-
❑ [[Hip replacement surgery]]<br>
|Chronic renal disease
❑ Knee replacement surgery<br>
|-
❑ [[General surgery|Major general surgery]]<br>
|Inflammatory bowel disease
❑ [[Trauma|Significant trauma]]<br>
|-
❑ [[Spinal cord injury]]<br>
|Cancer:(lung, gastrointestinal, pancreas, renal, breast, prostate, other)
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ Athroscopic knee surgery<br>
|-
❑ [[Central venous line]]s<br>
|Recent hospital admission
❑ [[Chemotherapy]]<br>
|-
❑ [[Chronic heart failure]]<br>
|Recent hip fracture or hip surgery (or both)
❑ [[Respiratory failure]]<br>
|-
❑ [[Hormone replacement therapy]]<br>
|Current use of [[antipsychotic]] drugs:(none, atypical, typical)
❑ [[Cancer]]<br>
|-
❑ [[Oral contraceptive pills]] <br>
|Current use of [[tamoxifen]]
❑ [[Stroke]] <br>
|-
❑ [[Pregnancy]] <br>
|Current use of [[hormone replacement therapy]]: (none, equine or non-equine hormone replacement therapy)
❑ [[Postpartum]] <br>
|-
❑ Prior history of [[VTE]] <br>
|Use of [[antiplatelets]]
❑ [[Thrombophilia]] <br>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ Bed rest for more than 3 days <br>
|Cardiovascular disease([[stroke]], [[transient ischaemic attack]], or [[coronary artery disease]])
❑ Prolonged car or air travel <br>
|-
❑ Advanced [[age]] <br>
|Atrial fibrillation
❑ [[Laparoscopic surgery]] <br>
|-
❑ Prepartum <br>
|Asthma
❑ [[Obesity]] <br>
|-
❑ [[Varicose veins]]
|[[Chronic obstructive pulmonary disease]]
|-
|Family history of venous thromboembolism
|}
|}


To calculate the risk prediction click [http://www.qthrombosis.org/index.php here]
The risk factors of VTE can be further classified into modifiable, non-modifiable and temporary.


===Modifiable Risk Factors===
===Modifiable Risk Factors===
Modifiable risk factors are reversible based upon lifestyle/behavior modification.
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.<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.<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]]
* [[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> Smoking significantly increases the risk of [[DVT]], particularly in women who are taking [[oral contraceptive pills]] as well as among obese people.
*** 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>
* Use of [[oral contraceptives]]<ref name="pmid17726684">{{cite journal| author=Pomp ER, Rosendaal FR, Doggen CJ| title=Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. | journal=Am J Hematol | year= 2008 | volume= 83 | issue= 2 | pages= 97-102 | pmid=17726684 | doi=10.1002/ajh.21059 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17726684  }} </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]].
* Prolonged travel: 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>
 
* [[Hyperhomocysteinemia]]:<ref name="pmid8592549">{{cite journal| author=den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH et al.| title=Hyperhomocysteinemia as a risk factor for deep-vein thrombosis. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 12 | pages= 759-62 | pmid=8592549 | doi=10.1056/NEJM199603213341203 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8592549  }} </ref> [[Hyperhomocysteinemia]] can be reduced with vitamin B supplementation.


===Non-Modifiable Risk Factors===
===Non-Modifiable Risk Factors===
* '''Age:''' The risk of DVT increases with age.
* Advanced age
* [[Heart failure]]
* [[Heart failure]]
* [[Thrombophilia]] or [[hypercoagulable state]]
* [[Thrombophilia]] or [[hypercoagulable state]]
** [[Factor V Leiden]]
** [[Prothrombin G20210A mutation]]
** [[Protein C deficiency]]
** [[protein S deficiency]]
** [[Antithrombin deficiency]]
** [[Activated protein C resistance]]
** [[Antithrombin III deficiency]]
** [[Factor VIII]] mutation
** [[Antiphospholipid syndrome]]
** [[Heparin induced thrombocytopenia]]
** [[Nephrotic syndrome]]
** [[Paroxysmal nocturnal hemoglobinuria]]
* [[Polycythemia vera]]
* [[Polycythemia vera]]


===Temporary Risk Factors===
===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.<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]], 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>
* 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 that causes [[stasis]] in the deep veins which may occur after surgery, with prolonged bedrest, or prolonged seating during travel
* 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
* [[Pregnancy]] and the peri-partum period
* Active [[cancer]]
* Active [[cancer]]
* [[Central venous catheter]]
* [[Central venous catheter]]
===Wells Score===
The Wells score is simple, and it is the 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]].<ref name="pmid7752753">{{cite journal |author=Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D'Ovidio R, Cogo A, Prandoni P |title=Accuracy of clinical assessment of deep-vein thrombosis |journal=[[Lancet]] |volume=345 |issue=8961 |pages=1326–30 |year=1995|month=May |pmid=7752753 |doi= |url= |accessdate=2012-04-26}}</ref><ref name="pmid9867786">{{cite journal |author=Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Use of a clinical model for safe management of patients with suspected pulmonary embolism |journal=Ann Intern Med |volume=129 |issue=12 |pages=997-1005 |year=1998|pmid=9867786}}</ref><ref name="pmid10744147">{{cite journal | author = 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 | title = Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. | journal = Thromb Haemost | volume = 83 | issue = 3 | pages = 416-20 | year = 2000 | id = PMID 10744147}}</ref><ref name="pmid11453709">{{cite journal |author=Wells PS, Anderson DR, Rodger M, Stiell I, Dreyer JF, Barnes D, Forgie M, Kovacs G, Ward J, Kovacs MJ |title=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 |journal=Ann Intern Med |volume=135 |issue=2 |pages=98-107 |year=2001|pmid=11453709 | url=http://www.annals.org/cgi/content/full/135/2/98}}</ref>
'''[[Wells score calculator|Wells Score Calculator for PE]]'''
{| class=wikitable border=1
!Variable
!Wells<ref name="pmid10744147">{{cite journal |author=Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, Turpie AG, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J |title=Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer |journal=Thromb. Haemost. |volume=83 |issue=3 |pages=416–20 |year=2000 |month=March |pmid=10744147 |doi=|url=http://www.schattauer.de/index.php?id=1268&L=1&pii=th00030416&no_cache=1 |accessdate=2012-05-01}}</ref>
|-
|Clinically suspected [[DVT]] (leg swelling, pain with palpation)
|style="text-align:center"|3.0
|-
|Alternative diagnosis is less likely than PE
|style="text-align:center"|3.0
|-
|Immobilization/[[surgery]] in previous four weeks
|style="text-align:center"|1.5
|-
|Previous history of [[DVT]] or [[PE]]
|style="text-align:center"|1.5
|-
|[[Tachycardia]] (heart rate more than 100 bpm)
|style="text-align:center"|1.5
|-
|[[Malignancy]] (treatment for within 6 months, palliative)
|style="text-align:center"|1.0
|-
|[[Hemoptysis]]
|style="text-align:center"|1.0
|-
|}
====Wells Criteria <ref name="pmid10744147"/><ref name="pmid11453709"/>====
* The following scoring system is used for assessment of risk<ref name="pmid17185658">{{cite journal |author=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 |title=Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators |journal=Radiology |volume=242 |issue=1 |pages=15-21 |year=2007 |doi=10.1148/radiol.2421060971 | pmid=17185658}}</ref> and need for further testing with [[Pulmonary embolism D-dimer|D-dimer]] or [[Pulmonary embolism CT|CT]] scan:
** Score > 6.0 - High probability (~59%).
** Score 2.0 to 6.0 - Moderate probability (~29%).
** Score < 2.0 - Low probability (~15%).


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


[[Category:Disease]]
[[Category:Disease]]

Revision as of 20:00, 30 May 2014

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

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Risk calculators and risk factors for Deep vein thrombosis risk factors

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 classified as temporary, modifiable and non-modifiable. It is suggested that venous thrombosis also shares risk factors with artery thrombosis, such as obesity, hypertension, smoking, and diabetes mellitus.[1]

Risk Factors

Shown below is a list of predisposing factors to VTE.[2][3] The risk factors are classified as strong, moderate and weak depending on how strongly they predispose for a VTE.

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

The risk factors of VTE can be further classified into modifiable, non-modifiable and 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.[4] [5] [6]
  • Prolonged travel: 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.[8]

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[2]
  • Prolonged immobilization that 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. ↑ Goldhaber SZ (2010). "Risk factors for venous thromboembolism". J Am Coll Cardiol. 56 (1): 1–7. doi:10.1016/j.jacc.2010.01.057. PMID 20620709.
  2. ↑ 2.0 2.1 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.
  3. ↑ 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Pomp ER, Rosendaal FR, Doggen CJ (2008). "Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use". Am J Hematol. 83 (2): 97–102. doi:10.1002/ajh.21059. PMID 17726684.
  8. ↑ http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
  9. ↑ den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH; et al. (1996). "Hyperhomocysteinemia as a risk factor for deep-vein thrombosis". N Engl J Med. 334 (12): 759–62. doi:10.1056/NEJM199603213341203. PMID 8592549.

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