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venous_thromboembolism

Venous thromboembolism

Venous thromboembolism (VTE) is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE).

Epidemiology

Thromboembolic diseases are of major clinical concern due to their high prevalence and consequences, which are often fatal. Venous thromboembolism (VTE) is estimated to be the third most common cardiovascular disorder after coronary heart disease and stroke 1).

Approximately 500,000 cases of venous thromboembolism (VTE) are reported annually in the United States.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are two clinical manifestations of VTE. In fact, VTE is essentially a massive PE, causing death in 70% within the first hour following the onset of symptoms.

VTEs are associated with longer hospitalizations, a decreased likelihood of being discharged home, and overall increases of hospital resource utilization and cost in inpatient and outpatient settings. VTE patients generate greater charges in the outpatient setting and are more likely to become readmitted at 6, 12, and 18 months after surgery, demonstrating a significant socioeconomic impact long after occurrence 2).

Risk factors

High grade glioma

Pathophysiology

An inflammatory reaction is usually present, mainly in the superficial veins and, for this reason this pathology is called most of the time thrombophlebitis. In fact, the inflammatory reaction and the white blood cells play a role in the resolution of venous clots.

Whether an ischemic stroke is due to a noncardiogenic or cardiogenic source, the mechanism of causing a stroke is the same. Both sources are involved with the development of thrombi or emboli that move from their original source to the brain blocking blood flow in the process. Known as Virchow’s triad, venous stasis, vascular injury, and hypercoagulability are major components in the development of thrombi.

Blood clot formed due to blood changes in which cellular material, such as red and white blood cells and platelets, become bound together by fibrin strands. Deep Vein Thrombosis (DVT), forming in the veins of the lower limbs, are the most common emboli associated with pulmonary emboli.

Clinical features

Nonspecific; pain, tenderness, swelling, discoloration (paleness or redness) in lower extremities. Pulmonary Embolism

Thrombus arising within the circulatory system and obstructing pulmonary blood flow in the pulmonary artery or any of its branches.

Nonspecific, insensitive, clinically silent.

Common signs — dyspnea, tachypnea, chest pain, shock, hemoptysis

Prophylaxis

Treatment

Treatment of venous and arterial thrombotic phenomena represents a major medical challenge, and the development of anticoagulant drugs represents a revolution in medicine.

Non vitamin K oral anticoagulant have been shown to be effective in the prevention and treatment of VTE and in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) 3) 4).

1)
Goldhaber SZ. Pulmonary embolism thrombolysis: a clarion call for international collaboration. J Am Coll Cardiol. 1992;19(2):246–247.
2)
Li AY, Azad TD, Veeravagu A, Bhatti I, Li A, Cole T, Desai A, Ratliff JK. Impact of Inpatient Venous Thromboembolism Continues After Discharge: Retrospective Propensity Scored Analysis in a Longitudinal Database. Clin Spine Surg. 2016 Oct 12. PubMed PMID: 27750270.
3)
Holy EW, Beer JH. Update on the status of new oral anticoagulants for stroke prevention in patients with atrial fibrillation. Cardiovasc Med. 2013;16:103–114.
4)
Heidbuchel H, Verhamme P, Alings M, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2013;15(5):625–651.
venous_thromboembolism.txt · Last modified: 2018/12/10 08:14 by administrador