Deep vein thrombosis natural history, complications and prognosis
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] Ujjwal Rastogi, MBBS [3]; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep Vein Thrombosis Microchapters |
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Treatment |
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Overview
Thrombus formation typically begins in the calf veins and naturally progresses to the proximal veins and ultimately, breaks free from the site formation and travels to the pulmonary artery where it is called a pulmonary embolism. In many cases, patients with a thrombus can be asymptomatic until it progresses into the proximal veins.
Natural History
- Many patients with a deep vein thrombosis (DVT) originating in the calf veins are asymptomatic until proximal vein involvement.[1]
- About half of all calf DVTs resolve spontaneously, without intervention.[1]
- One-sixth of all calf DVTs progress to involvement with the proximal veins.[1]
- Typical onset of thrombus formation may occur during the intraoperative period though there is potential latent onset up to many months after the initial surgery.[1]
- Surgeries characteristically responsible for thrombus formation include:
- Knee replacement surgery is associated with twice the frequency of asymptomatic onset.[1]
- Without treatment, one-fourth to one-third of symptomatic, isolated distal thrombus in the deep veins involve proximal veins.[1]
- Patients with isolated calf DVT treated with five days of heparin therapy without a tandem oral anticoagulant therapy were at highest risk for recurrent or extension of DVT within three months of follow-up.[1]
- Patients with untreated DVT have the potential to develop:
- Post-phlebitic syndrome (occurs in 10-30% of all DVT cases)
- Pain
- Edema
- Skin discoloration
- Ulceration
- Chronic venous insufficiency
- Mortality rates associated with venous thrombosis can be very high.
Complications
Venous thrombosis may lead to any of the following major complications:
- Recurrence may occur unevenly across the sexes; with men being almost four times more likely than women for a venous thrombosis recurrence.[3]
- Major bleeding due to anticoagulation
- Death - Proximal vein thrombosis is responsible for more than ninety percent of acute pulmonary embolism. Acute PE is ultimately associated with a high mortality if not treated promptly. [4]
Other complications include:
- Post-thrombotic syndrome
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
- Lemierre syndrome
- Septic pelvic thrombophlebitis
- Thrombosis is also associated with impaired quality of life, particularly when post-thrombotic syndrome develops.[5]
Prognosis
- Thirty five percent of the patients die suddenly.
- Thirty day mortality
- For deep venous thrombosis alone 5%
- For pulmonary embolism 45%
- Combined(PE and DVT) mortality is 30%
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Kearon C (2003). "Natural history of venous thromboembolism". Circulation. 107 (23 Suppl 1): I22–30. doi:10.1161/01.CIR.0000078464.82671.78. PMID 12814982. Unknown parameter
|month=ignored (help) - ↑ White RH (2003). "The epidemiology of venous thromboembolism". Circulation. 107 (23 Suppl 1): I4–8. doi:10.1161/01.CIR.0000078468.11849.66. PMID 12814979.
- ↑ Kyrle PA, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S (2004). "The risk of recurrent venous thromboembolism in men and women". N Engl J Med. 350 (25): 2558–63. doi:10.1056/NEJMoa032959. PMID 15201412. Review in: ACP J Club. 2004 Nov-Dec;141(3):78
- ↑ Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I (2009). "Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study". Thromb. Haemost. 102 (3): 493–500. doi:10.1160/TH09-01-0053. PMID 19718469. Retrieved 2011-12-14. Unknown parameter
|month=ignored (help) - ↑ Kahn SR, Ducruet T, Lamping DL, Arsenault L, Miron MJ, Roussin A; et al. (2005). "Prospective evaluation of health-related quality of life in patients with deep venous thrombosis". Arch Intern Med. 165 (10): 1173–8. doi:10.1001/archinte.165.10.1173. PMID 15911732.