Deep vein thrombosis risk factors

Jump to navigation Jump to search

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

Deep Vein Thrombosis Microchapters

Home

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

Trials

Landmark Trials

Case Studies

Case #1

Deep vein thrombosis risk factors On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Deep vein thrombosis risk factors

CDC on Deep vein thrombosis risk factors

Deep vein thrombosis risk factors in the news

Blogs on Deep vein thrombosis risk factors

Directions to Hospitals Treating Deep vein thrombosis

Risk calculators and risk factors for Deep vein thrombosis risk factors

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.

Risk Factors

Recently a research group[1]. 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:

  • History of venous thrombosis
  • Family history of venous thrombosis.
  • Pregnant patients
  • Patients on Anticoagulations
  • Symptoms suggestive of thrombosis.

The various variables that are taken into account are as follows

Age
Body mass index
Smoking status (non-smoker; ex-smoker; light, moderate, or heavy smoker)
Townsend deprivation score
Varicose veins
Congestive cardiac failure
Rheumatoid arthritis
Chronic renal disease
Inflammatory bowel disease
Cancer:(lung, gastrointestinal, pancreas, renal, breast, prostate, other)
Recent hospital admission
Recent hip fracture or hip surgery (or both)
Current use of antipsychotic drugs:(none, atypical, typical)
Current use of tamoxifen
Current use of hormone replacement therapy: (none, equine or non-equine hormone replacement therapy)
Use of antiplatelets
Cardiovascular disease(stroke, transient ischaemic attack, or coronary artery disease)
Atrial fibrillation
Asthma
Chronic obstructive pulmonary disease
Family history of venous thromboembolism

To calculate the risk prediction click here

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.[2] [3] [4]
    • Within obesity, a number of additional behaviors can further contribute to an increased risk of VTE including:[2]
      • 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. [5]
  • Homocysteine: Elevated homocysteine has been reported as a risk factor for venous thrombosis and levels can be reduced with B vitamin supplementation.[6]
  • Smoking: Significantly increases the risk of DVT, particularly in women who are taking oral contraceptive pills.

Non-Modifiable 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.[7]
  • Injury to a deep vein from surgery, a fracture, or other trauma, especially a paralytic spinal cord injury. [8]
  • 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

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.[9][10][11][12]

Wells Score Calculator for PE

Variable Wells[11]
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 [11][12]

  • The following scoring system is used for assessment of risk[13] 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. ↑ Hippisley-Cox J, Coupland C (2011). "Development and validation of risk prediction algorithm (QThrombosis) to estimate future risk of venous thromboembolism: prospective cohort study". BMJ. 343: d4656. doi:10.1136/bmj.d4656. PMC 3156826. PMID 21846713. line feed character in |title= at position 12 (help)
  2. ↑ 2.0 2.1 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
  6. ↑ Cattaneo M (2006). "Hyperhomocysteinemia and venous thromboembolism". Semin Thromb Hemost. 32 (7): 716–23. doi:10.1055/s-2006-951456. PMID 17024599.
  7. ↑ 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.
  8. ↑ 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. Unknown parameter |month= ignored (help)
  9. ↑ 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)
  10. ↑ 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.
  11. ↑ 11.0 11.1 11.2 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.
  12. ↑ 12.0 12.1 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.
  13. ↑ 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.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Deep_vein_thrombosis_risk_factors&oldid=839208"