Deep Vein Thrombophlebitis

BASICS

Development of blood clot within the deep veins of the body, usually as a result of surgery or trauma to blood vessels, accompanied by inflammation of the vessel wall
Major clinical consequences are embolization (usually to the lung), recurrent thrombosis, and postphlebitic syndrome.

Age- and gender-adjusted incidence of venous thromboembolism (VTE) is 100 times higher in the hospital than in the community. Almost half of all VTEs occur either during or soon after discharge from a hospital stay or surgery.
10–30% of patients diagnosed with deep venous thrombosis (DVT) and/or pulmonary embolism (PE) will die within 1 month of diagnosis.
1/3 (about 33%) of people with DVT/PE will have a recurrence within 10 years.
Of patients with VTE, 20% are complicated with PE. The 28-day DVT fatality rate is 5.4%; at 1 year, 20%; at 3 years, 29%.

In the United States, VTE incidence is 50.4/100,000 person per year.
Increased incidence in Caucasian and African American populations and with aging
Most common site: lower extremity DVT
Incidence in pregnancy: ~0.5 to 3/1,000
1–5% of central venous catheters are complicated by thrombosis.

Variable; depends on medical condition or procedure
At the time of DVT diagnosis, as many as 40% of patients also have asymptomatic PE; conversely, 30% of patients diagnosed with PE do not a have demonstrable source.
Present in 11% of patients with acquired brain injury entering neurorehabilitation

Factors involved may include venous stasis, endothelial injury, and hypercoagulability (Virchow triad).

Factor V Leiden, the most common thrombophilia, is found in 5% of the population and in 10–65% of all VTE events and increases VTE risk 3- to 6-fold.
Prothrombin G20210A is found in 3% of Caucasians; increases the risk of thrombosis ~3-fold

Acquired: COVID-19 infection (up to 3 months after acute infection), previous DVT, cancer, immobilization, trauma, traumatic brain injury, recent major surgery, medications (oral/transdermal contraceptives, estrogens, tamoxifen, glucocorticoids), obesity, smoking, antiphospholipid syndrome, acute infectious process, thrombocytosis, pregnancy/puerperium, central venous catheters, inflammatory bowel disease
Hereditary: deficiencies of protein C, protein S, or antithrombin III; factor V Leiden R506Q, prothrombin G20210A mutation, dysfibrinogenemia, elevated factor VIII activity, hyperhomocysteinemia

Mechanical thromboprophylaxis for patients with high bleeding risk
For acutely ill and for critically ill hospitalized patients at increased risk of thrombosis, low–molecular-weight heparin (LMWH), low-dose unfractionated heparin, or fondaparinux is recommended.

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