Predisposing factors for first and recurrent venous thrombosis

ESC CardioMed ◽  
2018 ◽  
pp. 2751-2755
Author(s):  
Willem M. Lijfering ◽  
Suzanne C. Cannegieter
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Venous Thrombosis ◽  
Case Fatality ◽  
Predisposing Factors ◽  
Medical Illness ◽  
Vein Thrombosis ◽  
Patient Will ◽  
Recurrent Venous Thrombosis

Venous thrombosis, which mainly manifests as deep vein thrombosis of the leg or pulmonary embolism, is a major contributor to global disease burden. With a recurrence rate of approximately 25% in 5 years, and a 30-day case fatality rate of 5–10%, identification of predisposing factors for venous thrombosis is imperative. Dozens of risk factors for first venous thrombosis are known today, which can be grouped into three categories: first venous thrombosis ‘provoked by a transient risk factor’, ‘provoked by a persistent risk factor’, or ‘unprovoked’. This chapter comments on how risk factors known today can be classified into these categories, how this classification determines recurrence risk, and how knowledge on predisposing risk factors should be interpreted and integrated for optimal clinical use. The chapter proposes that predisposing factors for venous thrombosis are not the same for each high-risk situation. This is important to consider when one wants to identify high-risk groups in, for example, cancer patients, surgical patients, in patients with a medical illness, or in patients at risk for recurrent venous thrombosis. This way it will be possible to expose only those patients at unacceptably high risk of thrombosis to the risks and burden of anticoagulant treatment. In conclusion, the knowledge on predisposing factors for venous thrombosis is extensive, but the patient will benefit most when this knowledge is properly integrated, depending on the clinical situation.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors

Blood ◽  
2013 ◽  
Vol 122 (26) ◽  
pp. 4264-4269 ◽  
Author(s):  
Rachel E. J. Roach ◽  
Willem M. Lijfering ◽  
Astrid van Hylckama Vlieg ◽  
Frans M. Helmerhorst ◽  
Frits R. Rosendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Superficial Vein ◽  
Thrombotic Risk ◽  
Vein Thrombosis ◽  
Thrombotic Risk Factor ◽  
Key Points ◽  
Superficial Vein Thrombosis ◽  
History Of

Key Points Superficial vein thrombosis combined with an acquired thrombotic risk factor increases the risk of venous thrombosis 10- to 100-fold. If confirmed, these findings have important implications for the future prevention of venous thrombosis.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

Risk Factors for Venous Thrombotic Disease

1999 ◽  
Vol 82 (08) ◽  
pp. 610-619 ◽  
Author(s):  
F.R. Rosendaal
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Prophylactic Treatment ◽  
Case Fatality ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
Adequate Knowledge ◽  
Cerebral Sinus ◽  
Portal Veins ◽  
Deep Vein

IntroductionVenous thrombosis occurs in about 1 per 1,000 individuals per year.1,2 It usually affects the deep veins of the leg, but may occur in other sites, such as the upper extremities, cerebral sinus, liver and portal veins, or retinal veins. It also may occur in the superficial veins, usually in the leg. The predilection of thrombosis occurring in the leg is the result of the upright position of man, with the resulting slow antigravitational flow of blood in the veins of the leg. Embolization occurs when parts of the clot dislodge and are transported by the blood flow, usually through the heart to the vasculature of the lungs.3 Thrombosis is a serious disorder. It may be fatal by pulmonary embolism, although this is rare (case fatality rate of venous thrombosis is estimated at 1% to 2%). A common, and often disabling, consequence of deep vein thrombosis is postthrombotic syndrome, with symptoms ranging from discoloration to pain and ulceration.4 Because thrombosis is not very rare and often has serious consequences, prophylactic treatment is focussed on preventing first events and recurrences through adequate knowledge about risks and risk factors.5

Development and Testing of a Risk Assessment Model for Venous Thrombosis in Medical Inpatients: the Medical Inpatients and Thrombosis (MITH) Study Score

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 173-173
Author(s):  
Neil Zakai ◽  
Peter Callas ◽  
Allen Repp ◽  
Mary Cushman
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Factor ◽  
High Risk ◽  
Venous Thrombosis ◽  
Medical Record ◽  
The United States ◽  
Assessment Model ◽  
C Statistic ◽  
Medical Inpatients

Abstract Abstract 173FN2 Introduction: Multiple government organizations (i.e. the Joint Commission in the United States and the National Institute for Health and Clinical Excellence in the United Kingdom) mandate venous thrombosis (VT) risk assessment for hospitalized patients and provision of VT prophylaxis, however there are no validated VT risk assessment models (RAM) available for use in medical inpatients. Methods: Between January 2002 and June 2009 all cases of VT complicating medical admissions were identified using ICD-9 codes and confirmed by medical record review at a 500 bed teaching hospital. Two controls without VT were frequency matched to each case by admission service (medicine, cardiology, and oncology) and admission year. VT required positive imaging or autopsy. Medical history, presenting conditions, and use of VT prophylaxis in cases and controls were assessed by chart review. Weighted logistic regression was used to calculate odds ratios (OR) and the Taylor series method for 95% confidence intervals (CI) accounting for VT prophylaxis use (both mechanical and pharmacologic). A RAM was developed using clinical judgment and sequentially adding risk factors into a multivariable model. A point value was assigned for each risk factor by dividing the b coefficients' by the lowest b coefficient value and rounding to the nearest integer. To validate the model, the 95% CI for the C-statistic was calculated using bootstrapping with 1000 replicate samples. Results: 299 cases of VT and 601 matched controls were reviewed. The rate of VT per 1000 admissions (95% CI) was 4.6 (3.9, 5.4). Table 1 presents the RAM with the point value for each risk factor. The c-statistic for the model was 0.73 (95% CI 0.70, 0.76). Using a cut-off of ≥2 points as high risk, 79% of cases and 39% of controls were classified as high risk. The probability of VT in the absence of VT prophylaxis for a score <2 was 1.5 (95% CI 1.0, 2.3) per 1000 admissions and for a score ≥2 was 8.8 (95% CI 4.1, 18.8) per 1000 admissions. To evaluate a score assessed by clinical characteristics only, we assessed a score with the same risk factors but removing platelet count and white cell count from the model. The C-statistic was 0.71 (95% CI 0.68, 0.74) and 74% of cases and 39% of controls were high risk. Stratification by admission service or admission to an intensive care unit did not affect interpretation of the results. Conclusion: We present an internally validated RAM that assesses the risk of VT complicating medical admission. The score is simple, relies only on information easily known at the time of admission, and could be incorporated into an electronic medical record. It will allow clinicians to assess VT risk at admission for medical inpatients and weigh the risks and benefits of pharmacologic VT prophylaxis. The RAM will enable further studies to determine optimal VT prevention strategies in medical inpatients. Disclosures: No relevant conflicts of interest to declare.

Venous Thromboembolism

2020 ◽  
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Antithrombotic Agents ◽  
Vein Thrombosis ◽  
Recurrent Venous Thrombosis ◽  
Deep Vein ◽  
D Dimer ◽  
In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites).  This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

scholarly journals Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group

2016 ◽  
Vol 34 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Brenda J. Weigel ◽  
Elizabeth Lyden ◽  
James R. Anderson ◽  
William H. Meyer ◽  
David M. Parham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Bone Marrow Involvement ◽  
High Risk Group ◽  
Historical Cohort ◽  
Dismal Prognosis ◽  
Risk Patients ◽  
Metastatic Sites

Purpose Patients with metastatic rhabdomyosarcoma (RMS), except those younger than 10 years with embryonal RMS, have an estimated long-term event-free survival (EFS) of less than 20%. The main goal of this study was to improve outcome of patients with metastatic RMS by dose intensification with interval compression, use of the most active agents determined in phase II window studies, and use of irinotecan as a radiation sensitizer. Patients and Methods Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites). Results One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies. Conclusion Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.

scholarly journals Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

2021 ◽  
Vol 15 ◽  
pp. 117954842098665
Author(s):  
Muhanad Taha ◽  
Paul Nguyen ◽  
Aditi Sharma ◽  
Mazen Taha ◽  
Lobelia Samavati
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Venous Thrombosis ◽  
Case Summary ◽  
One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

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