Deep Vein Thrombophlebitis
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- 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.
- 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%.
- 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).
- 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 hypercoagulability (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
- Acquired: previous DVT, cancer, immobilization, trauma, obesity, recent major surgery, medications (oral contraceptives, estrogens, tamoxifen), obesity, smoking, antiphospholipid syndrome, acute infectious process, thrombocytosis, pregnancy/puerperium, central venous catheters
- 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 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.
- In patients undergoing major abdominal surgery for malignancy, LMWH for up to 4 weeks after surgery have been shown to decrease the incidence of VTE without increased bleeding.