Deep Vein Thrombophlebitis

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Description

  • An obstructive disease due to blood clots forming in the deep veins of the body (deep venous thrombosis [DVT]), most commonly in the lower extremities, and accompanied by inflammation of the vessel wall
  • Classified as provoked or idiopathic

Epidemiology

  • In United States: annually >200,000 people develop venous thrombosis
  • ~1 in 5 cases are related to cancer and/or cancer treatment.
  • Pregnancy, childbirth, or in the 3-months postpartum increases risk in women by 5-fold
  • 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.

Incidence

  • United States: DVT incidence is ~80 cases per 100,000.
  • Increased incidence in White and African American populations and with aging
  • Incidence in pregnancy: ~0.5 to 3.0 cases per 1,000; 1–5% of central venous catheters are complicated by thrombosis.

Prevalence

  • Prevalence of lower limb DVT is ~1 case per 1,000 population.
  • At the time of DVT diagnosis, as many as 40% of patients also have asymptomatic pulmonary embolism (PE); conversely, 30% of patients diagnosed with PE do not a have demonstrable source.

Etiology and Pathophysiology

Virchow Triad: Factors involved may include venous stasis (due to venous obstrcution, shock, CHF), endothelial injury (due to trauma, inflammation, surgery), and hypercoagulability (due to malignancy, nephrotic syndrome, HRT); commonly due to mechanical injury to the vein, and increased venous pressure

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 whites; increases the risk of thrombosis ~3-fold

Risk Factors

  • Constitutional: obesity, pregnancy, advanced age (>60 years), surgery, critical care admission
  • Acquired: infections (e.g., COVID-19 up to 3 months after acute infection), disseminated intravascular coagulation, immobility (bed rest, surgical procedures, stroke, long-flights or drives), malignancy, previous DVT, pregnancy/puerperium, trauma, increased blood viscosity, medications (oral/transdermal contraceptives, hormonal therapies, chemotherapy), central venous catheters
  • Hereditary: deficiencies of protein C, protein S, or antithrombin III; factor V Leiden mutation (R506Q), prothrombin G20210A mutation, dysfibrinogenemia, elevated factor VIII activity, hyperhomocysteinemia, sickle cell disease, polycythemia vera, autoimmune disease

General Prevention

  • Early ambulation and avoidance of prolonged immobilization
  • Mechanical thromboprophylaxis—particularly useful in high bleeding risk patients
  • Prophylactic anticoagulation when appropriate (e.g., acutely ill, critical illness, debility)

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