VENOUS THROMBOEMBOLISM
§ Thrombi and clots can form in the deep veins of the legs, which can travel as an embolus to other areas
such as the heart (to cause an MI) or the lung vasculature (to cause a PE)
Post-thrombotic syndrome – condition that occurs in people who have had a DVT, it can cause chronic pain,
swelling and other leg symptoms (aching, cramping, heaviness, itching, tingling, swelling, skin discolouration,
hardening of skin, varicose veins and venous ulcers)
§ Mostly develops within 2 years of DVT diagnosis
§ Variable severity
§ Causes reduced QoL
(!) most cases of mortality from a DVT/PE have been due to diagnostic failure rather than treatment failure (!)
Virchow’s triad – 3 key factors that are important/contributory in the development of venous thrombosis
1. Blood stasis/flow
2. Endothelial injury
3. Blood coagulability
Risk factors
Major:
§ Hip/pelvic fracture
§ Hip/knee replacement surgery
§ Major general surgery (esp for malignancy)
§ Major trauma
§ Spinal cord injury
§ Hospitalisation with acute medical illness
Moderate:
§ Previous VTE
§ Malignancy/chemotherapy
o Cancer is pro-thrombotic
o Also due to immobility, chemo treatment and frequency of central venous lines
o 2nd leading cause of death in cancer patients is VTE
§ Pregnancy and post-partum period
o PE is leading cause of maternal death
o Most important factors within this population include:
§ Obesity
§ Maternal age >35
§ C-section (esp emergency)
§ COCP/hormone therapy
§ Central venous line
§ Thrombophilia
§ Other medical conditions – nephrotic syndrome, IBD, Behcets syndrome
Mild:
§ Age
§ Travel
§ Obesity
§ Varicose veins
§ Diet
§ Smoking
§ Air pollution
§ Thrombi and clots can form in the deep veins of the legs, which can travel as an embolus to other areas
such as the heart (to cause an MI) or the lung vasculature (to cause a PE)
Post-thrombotic syndrome – condition that occurs in people who have had a DVT, it can cause chronic pain,
swelling and other leg symptoms (aching, cramping, heaviness, itching, tingling, swelling, skin discolouration,
hardening of skin, varicose veins and venous ulcers)
§ Mostly develops within 2 years of DVT diagnosis
§ Variable severity
§ Causes reduced QoL
(!) most cases of mortality from a DVT/PE have been due to diagnostic failure rather than treatment failure (!)
Virchow’s triad – 3 key factors that are important/contributory in the development of venous thrombosis
1. Blood stasis/flow
2. Endothelial injury
3. Blood coagulability
Risk factors
Major:
§ Hip/pelvic fracture
§ Hip/knee replacement surgery
§ Major general surgery (esp for malignancy)
§ Major trauma
§ Spinal cord injury
§ Hospitalisation with acute medical illness
Moderate:
§ Previous VTE
§ Malignancy/chemotherapy
o Cancer is pro-thrombotic
o Also due to immobility, chemo treatment and frequency of central venous lines
o 2nd leading cause of death in cancer patients is VTE
§ Pregnancy and post-partum period
o PE is leading cause of maternal death
o Most important factors within this population include:
§ Obesity
§ Maternal age >35
§ C-section (esp emergency)
§ COCP/hormone therapy
§ Central venous line
§ Thrombophilia
§ Other medical conditions – nephrotic syndrome, IBD, Behcets syndrome
Mild:
§ Age
§ Travel
§ Obesity
§ Varicose veins
§ Diet
§ Smoking
§ Air pollution
