Deep vein thrombosis pathophysiology
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Overview
Rudolf Virchow noted several factors affecting the clot formation, which are:
1).Alterations in blood flow (stasis) : Normally the blood flow throughout the circulatory system, without significantly stopping or slowing any where. In certain pathological conditions where the blood flow slows down or stops, which causes
- a) Increases platelet/endothelium contact
- b) Decrease the dilution of clotting factors
This increases the risk of clot formation and form microthrombi, which further grow and propagate.
2).Injury to the vascular endothelium : Intrinsic or secondary to external trauma(for example in catheterization) can cause intimal damage and can stimulate the clot formation.
3).Alterations in the constitution of blood (hypercoagulability) :This lead to the tendency to develop blood clots(Thrombosis).
These three conditions are collectively known as Virchow's triad.
More deep venous thrombosis occurred in the left leg than in the right, the underlying cause being the compression of the left common iliac vein by the overlying right common iliac artery.(see May-Thurner syndrome)
Thrombi usually develop first in the calf veins, "growing" in the direction of blood flow. DVTs are distinguished as being above or below the popliteal vein. Very extensive DVTs can extend into the iliac veins or the inferior vena cava. The risk of pulmonary embolism is higher in the presence of more extensive clots.
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