TITLE: VENOUS THROMBOEMBOLISM
AUTHOR: SUSAN M. BEGELMAN, MD -- Department of Cardiovascular Medicine
PUBLISHED: MAY 29, 2002
    
Table 1:
Risk Factors for Venous Thromboembolic Disease
Stasis/
Endothelial Injury
Thrombophilias
Medical
Conditions
Drugs
Other
Indwelling
venous device		 Activated protein C resistance

Malignancy
(Solid-tumor and myeloproliferative disorders)

 Oral contraceptive use Increasing age
Surgery
(most commonly
pelvic and orthopedic)		 Factor V Leiden Pregnancy Hormone replacement therapy
Major trauma, fracture Prothrombin gene mutation G20210A Myocardial infarction Chemotherapy (including tamoxifen)
Prolonged travel Hyperhomocysteinemia Congestive heart failure
Paralysis
(including anesthesia for > 30 min)		 Anticardiolipin antibodies Stroke
Varicose veins Lupus anticoagulant Obesity
  Elevated factor VIII level Inflammatory bowel disease
  Protein C deficiency Nephrotic syndrome
  Protein S deficiency History of DVT
  Dysfibrinogenemia Heparin-induced thrombocytopenia
  Dysplasminogenemia Paroxysmal nocturnal hemoglobinuria    
  

 

Table 2:
Differential Diagnosis of Pulmonary Embolism
  • Angina
  • Anxiety
  • Aortic dissection
  • Asthma
  • Congestive heart failure
  • Costochondritis
  • Esophageal spasm
  • Exacerbation of chronic obstructive pulmonary disease
  • Malignancy
  • Musculoskeletal pain
  • Pericarditis
  • Pneumonia
  • Pneumothorax
  • Rib fracture

 

Table 3:
Diagnositic Accuracy of Pulmonary Embolism
Combing Clinical Assessment and
Lung Scintigraphy (PIOPED)
Scan Probability
Clinical Probability
High
Intermediate
Low
High
96%
88%
56%
Intermediate
66%
28%
16%
Low
40%
16%
4%

Adapted from reference 14 (the PIOPED Investigators)
with permission.

 

Table 4:
Duration of Therapy for Venous Thromboembolism: Current Guidelines from the
American College of Chest Physicians
Duration of Therapy
Indication
3 to 6 mo First event with reversible* or time-limited risk factor (patient may have underlying factor V Leiden or prothrombin G20210A)
6 mo
or more		 Idiopathic venous
thromboembolism, first event
1 yr to
lifetime

First event† with:

  • Cancer, until resolved
  • Anticardiolipin antibody
  • Antithrombin deficiency
  • Recurrent event, idiopathic or with thrombophilia

* Surgery, trauma, immobilization, estrogen use.

† The proper duration of therapy is unclear in a first event with homozygous factor V Leiden, hyperhomocysteinemia, deficiency of protein C or S, or multiple thrombophilias and in recurrent events with reversible risk factors.

Adapted from reference 26 (Hyers TM et al) with permission of the publisher.