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Peripheral Artery Disease: causes and consequences

Coronary Artery Disease: causes and consequences

Making connections: Stroke risk in patients with multiple co-morbidities

This section focuses on deep-vein thrombosis and discusses its risk factors, epidemiology and associated complications

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:
    • 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
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Pulmonary embolus. Whole lung in which pulmonary arteries are obstructed by fresh (red) thrombus (circles)

  • 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
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Deep vein thrombosis. Vein with thrombus in lumen

  • 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
  • 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
  • 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
References

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