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High-risk patients with atrial fibrillation: Spotlight on renal impairment
This section focuses on deep-vein thrombosis and discusses its risk factors, epidemiology and associated complications
In this section:
Venous Thrombosis
Video to explain the mode of action of venous thrombosis. Play this video to get an overview about venous thrombosis.
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Venous thrombi
- Venous thrombi:
- Feature enmeshed erythrocytes
- Tend to fragment, creating an embolusl
- Typically manifest as DVT and PE
- Formation of a thrombus within a vein is known as a venous thrombosis
- If the thrombus breaks loose and travels through the blood system, it is known as an embolus1
Pulmonary embolus. Whole lung in which pulmonary arteries are obstructed by fresh (red) thrombus (circles)
Venous thromboembolism
- The most common type of VTE is DVT, which predominantly occurs in the large veins of the leg1,2
- When part or all of a thrombus breaks away from the blood vessel wall, it travels in the direction of blood flow towards the lungs and can block one of the arteries in the lung (a PE)
- Patients with DVT are at risk of PE, which can potentially be life-threatening
Deep vein thrombosis. Vein with thrombus in lumen
Risk factors
- VTE is typically associated with cancer, trauma and surgery
- Idiopathic cases occur when a patient has no clear exposing risk factor (i.e. no triggering event).3 Pre-disposing risk factors for VTE include:4
- Increasing age (particularly >60 years)
- Pregnancy and postpartum
- Obesity (body mass index >30 kg/m2)
- Immobility (including lower extremity paralysis)
- Personal/family history of VTE
- Dehydration
- Use of oestrogen-containing oral contraceptives
- Use of hormone replacement therapy
- Exposing risk factors for VTE include:4
- Surgery
- Active cancer or cancer therapy
- Respiratory or heart failure
- Acute medical illness
- Critical care admission
- Venous compression (e.g. by tumour, haematoma, arterial abnormality)
- Recent MI or stroke
- Metabolic, endocrine or respiratory pathologies
- Central venous catheterization
- Inflammatory bowel disease (e.g. ulcerative colitis or Crohn’s disease)
- Severe infection
- Myeloproliferative diseases
- Varicose veins with associated phlebitis
- Inherited or acquired thrombophilias
- Selective oestrogen receptor modulators
- Erythropoiesis-stimulating agents
- Nephrotic syndrome
- Paroxysmal nocturnal haemoglobinuria
- Long-distance travel
Incidence and prevalence
- Venous thromboembolic disease is a major problem worldwide5
- In ‘high-income’ Western countries, the annual incidence of VTE ranges between 75 and 269 per 100,000 individuals
- In studies from Taiwan, Hong Kong and Korea, the annual incidence is lower, ranging between 7.9 and 17.1 per 100,000 individuals
- Regardless, because the risk of VTE increases with age, the burden of VTE will grow globally with ageing populations
- As would be expected, DVT occurs more frequently than PE; e.g., in Europe the annual incidence of:6
- DVT (without PE) ranges between 45 and 117 per 100,000 individuals
- PE (with or without DVT) ranges between 29 and 78 per 100,000 individuals
- Approximately 1.1 million venous thromboembolic events occur each year across France, Germany, Italy, Spain, Sweden and the UK, consisting of:7
- 465,715 (41% of total) non-fatal DVT events
- 295,982 (26% of total) non-fatal PE events
- 370,012 (33% of total) VTE-related deaths
- In the US, the prevalence of VTE was estimated to be 0.95 million in 2006, with a projected future prevalence of 1.82 million cases by 20508
Associated complications
- VTE also can lead to serious long-term complications, including:
- PTS – the most common complication of DVT (a prevalence of 10–20% despite treatment), which typically causes chronic pain and swelling in the affected leg, and in severe cases can result in venous ulcers5,9
- CTEPH – (occurring in up to 4% of patients with PE) causes the right side of the heart to work harder than normal because of abnormally high blood pressure in the arteries of the lungs, leading to heart failure5,10
See Also
Peripheral Artery Disease: causes and consequences
See Also
Coronary Artery Disease: causes and consequences
References
- Turpie AGG, Esmon C. Venous and arterial thrombosis – pathogenesis and the rationale for anticoagulation. Thromb Haemost 2011;105:586–596. Return to content
- Mackman N. Triggers, targets and treatments for thrombosis. Nature 2008;451:914–918. Mackman N. Triggers, targets and treatments for thrombosis. Nature 2008;451:914–918. Return to content
- Turpie AGG, Chin BSP, Lip GYH. Venous thromboembolism: pathophysiology, clinical features, and prevention. Br Med J 2002;325:887–890. Turpie AGG, Chin BSP, Lip GYH. Venous thromboembolism: pathophysiology, clinical features, and prevention. Br Med J 2002;325:887–890. Return to content
- Geerts WH, Bergqvist D, Pineo GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133:381S–453S. Geerts WH, Bergqvist D, Pineo GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest 2008;133:381S–453S. Return to content
- Raskob GE, Angchaisuksiri P, Blanco AN et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014;34:2363–2371. Return to content
- Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015;12:464–474. Return to content
- Cohen AT, Agnelli G, Anderson FA et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756–764. Cohen AT, Agnelli G, Anderson FA et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756–764. Return to content
- Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: Current trends and future projections. Am J Hematol 2011;86:217–220. Return to content
- Kahn SR. The post-thrombotic syndrome: the forgotten morbidity of deep venous thrombosis. J Thromb Thrombolysis 2006;21:41–48. Return to content
- Tapson VF. Acute pulmonary embolism. N Engl J Med 2008;358:1037–1052. Return to content
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Updated date 10/10/2022
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