Embolism and thrombosis
- 1 Classification
- 2 Cause/etiology
- 3 Diagnosis
- 4 Treatment
- 5 Prognosis
- 6 Prevention
- 7 References
- 8 External links
Embolism and thrombosis is "a collective term for pathological conditions which are caused by the formation of a blood clot (thrombus) in a blood vessel, or by blocking of a blood vessel with an embolus, undissolved materials in the blood stream."
- Embolism, includes pulmonary embolism
- Venous thrombosis
The risk of venous thromboembolism can be estimated with http://www.qthrombosis.org/.
One risk factor is hypercoagulability due to cancer. Cancer can be found in up to 10% of patients within one year of embolism or thrombosis.
In a cohort study. the population attributable risk of venous thromboembolism was:
- 20% for ABO blood type
- 10% for factor V Leiden R506Q (Activated Protein C Resistance) via G1691A mutation
- 1% for prothrombin G20210A
The prevalence of malignancy is about:
- 3% of patients with first idiopathic venous thrombosis
- 17% of patients with idiopathic, idiopathic venous thrombosis
Duration of treatment
|Patients|| Duration of
| Duration of
|Campbell, 2007||DVT or PE without prior episode within 3 years||3 mos||6 mos||Prolonged tended to do slightly better|
|Schulman, 2003||DVT or PE. 13% had prior VTE.||6 mos||24 mos||Prolonged did better|
|Kearon, 2004||First episode of VTE due to transient risk factor||1 mo||3 mos||Prolonged did better|
|Ridker, 2003||Idiopathic VTE. 30% had prior VTE||6 mos||2.1 yrs||Prolonged did better|
|Agnelli, 2001||First episode of idiopathic DVT||3 mos||1 yr||Prolonged did better while anticoagulated, but after two years there was no difference|
|Kearon, 1999||First episode of idiopathic VTE.||3 mos||2 yrs||Prolonged did better|
|Pinede, 2001||DVT or PE without prior episode within 3 years|| 6 wks for distal DVT;
3 mos for proximal or PE
| 12 wks for distal DVT;
6 mos for proximal or PE
|Prolonged tended to do slightly better|
|Levine, 1995||Acute DVT with normal normal impedance plethysmogram (IPG) after 4 weeks||1 mo||3 mos||Prolonged tended to do better|
Clinical practice guidelines by the American College of Chest Physicians address the duration of anticoagulation for deep venous thrombosis and pulmonary embolism. Although initial trials suggested lack of benefit from prolonged anticoaguation, trials since 1995 favor longer anticoagulation. In patients who have had recurrent DVTs (two or more), anticoagulation is generally "life-long." The Cochrane Collaboration and others have meta-analyzed the risk and benefits of prolonged anti-coagulation.
|Single DVT due to transient risk factor||3 months|
|Single unprovoked DVT||at least 3 months (longer if favorable risks for anticoagulation)|
|Second episode of unprovoked VTE||long-term treatment|
|DVT in patients with cancer||LMWH for the first 3 to 6 months of long-term anticoagulant therapy|
Using D-dimer to determine duration of treatment
Using Ultrasonography to determine duration of treatment
- "If veins had not recanalized, we invited patients to have further ultrasonography after 3 and 9 months in patients with secondary DVT and after 3, 9, 15, and 21 months in those with unprovoked DVT. Anticoagulation was discontinued when the veins had recanalized, along with further ultrasonography"
|Treatment or test||Risk if treated or test result is favorable||Risk if not treated or test result is unfavorable||Comments|
|Randomized controlled trial||Aspirin 100 mg daily for 2 years||6% per year||11.2% per year||0.5% major bleeding|
|Randomized controlled trial||Rivaroxaban for 6-12 months||1% over 6-12 months||7% over 6-12 months||0.7% major bleeding|
|Systematic review of a diagnostic test||Normal d-dimer||4% per year||9% per year|
|Systematic review of a diagnostic test||Recanalization of veins (no residual vein obstruction or RVO)||Insignificant difference|
Extending treatment with aspirin
|ASPIRE, 2012|| 822 patients
• first-ever, unprovoked venous thromboembolism
• completed initial anticoagulant
|Aspirin 100 mg/day||Placebo||venous thromboembolism at 37 months||4.8%||6.5%||relative risk ratio = 0.74 (95% CI: 0.52 to 1.05; P=0.09)|
|WARFASA, 2012|| 502 patients
• first-ever, unprovoked venous thromboembolism
• completed initial anticoagulant
|Aspirin 100 mg/day||Placebo||venous thromboembolism at 24 months||6.6%||11.2%||
0.58 (95% CI: 0.36 to 0.93)
- During the initial 3 months of anticoagulation
- Recurrent VTE = 3.4%
- Recurrent fatal VTE was 0.4% (case-fatalityrate was 11.3%)
- Major bleeding was 1.6%
- Fatal major bleeding events was 0.2% (case-fatalityrate of 11.3%)
- Recurrent VTE = 3.4%
- After anticoagulation
- Recurrent VTE = 7.6% per 100 patient-years
- Recurrent fatal VTE was 0.3% per 100 patient-years (case-fatality rate was 3.6%)
- Recurrent VTE = 7.6% per 100 patient-years
Rosuvastatin, a hydroxymethylglutaryl-coenzyme A reductase inhibitor (statin), may reduce embolism and thrombosis according to the Jupiter randomized controlled trial.
- Anonymous (2015), Embolism and thrombosis (English). Medical Subject Headings. U.S. National Library of Medicine.
- The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Office of Public Health and Science (2008).
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- Glynn RJ, Danielson E, Fonseca FA, et al (March 2009). "A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism". N. Engl. J. Med.. DOI:10.1056/NEJMoa0900241. PMID 19329822. Research Blogging.