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Deep Vein Thrombophlebitis

Deep Vein Thrombophlebitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Development of blood clot within the deep veins, usually accompanied by inflammation of the vessel wall
  • Major clinical consequences are embolization (usually to the lung), recurrent thrombosis, and postphlebitic syndrome.

Epidemiology

  • 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.
  • Of patients with VTE, 20% complicated with pulmonary embolism (PE). The 28-day deep venous thrombosis (DVT) fatality rate is 5.4%; at 1 year, 20%; at 3 years, 29%.

Incidence
  • 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)
  • 1–5% of central venous catheters are complicated by thrombosis (2).
Prevalence
  • Variable; depends on medical condition or procedure
  • At 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

Etiology and Pathophysiology

Factors involved may include venous stasis, endothelial injury, and abnormalities of coagulation (Virchow triad).


Genetics
  • 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

Risk Factors

  • Acquired: previous DVT, age, cancer, immobilization, trauma, obesity, major surgery, orthopedic surgery, medications (oral contraceptives, estrogens), antiphospholipid syndrome, cerebrovascular accident, acute infectious process, thrombocytosis, pregnancy/puerperium, central venous catheters
  • Inherited: deficiencies of protein C, protein S, or antithrombin III; factor V Leiden R506Q, prothrombin G20210A, dysfibrinogenemia
  • Mixed/unknown: hyperhomocysteinemia, high levels of factor VIII, high levels of thrombin activatable fibrinolysis inhibitor (TAFI), high levels of factor XI

General Prevention

  • Mechanical thromboprophylaxis is recommended in patients with high bleeding risk and as adjunct to pharmacologic thromboprophylaxis.
  • 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 are recommended (3)[C].
  • For most patients, prolonged secondary prophylaxis is not recommended.

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Citation

Stephens, Mark B., et al., editors. "Deep Vein Thrombophlebitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816439/all/Deep_Vein_Thrombophlebitis.
Deep Vein Thrombophlebitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816439/all/Deep_Vein_Thrombophlebitis. Accessed April 20, 2019.
Deep Vein Thrombophlebitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816439/all/Deep_Vein_Thrombophlebitis
Deep Vein Thrombophlebitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 20]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816439/all/Deep_Vein_Thrombophlebitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Deep Vein Thrombophlebitis ID - 816439 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816439/all/Deep_Vein_Thrombophlebitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -