Deep vein thrombosis risk factors

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet; Rim Halaby, M.D. [3]

Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. In these chapters on VTE, the word risk factors refers to those epidemiologic and genetic variables that expose someone to a higher risk of developing venous thrombosis. The word triggers refer to those factors in the patients immediate history or environment that may have led to the occurrence of the venous thrombosis. The risk factors for VTE are a constellation of predisposing conditions which stem from the three principles of Virchow’s triad: stasis of the blood flow, damage to the vascular endothelial cells, and hypercoagulability. The risk factors for VTE can be classified as temporary, modifiable and non-modifiable. It is suggested that venous thrombosis also shares risk factors with arterial thrombosis, such as obesity, hypertension, smoking, and diabetes mellitus.^[1]

Shown below is a list of predisposing factors to VTE.^[2][3] The risk factors are classified as moderate or weak depending on how strongly they predispose for a VTE.

The risk factors of VTE can be further classified into modifiable, non-modifiable and temporary.

Modifiable risk factors are reversible based upon lifestyle/behavior modification.

• Obesity: Obesity is defined as a body-mass index (BMI) above 30 kg/m2.^{[4] [5] [6]}

• Smoking:^[4] Smoking significantly increases the risk of DVT, particularly among women who are taking oral contraceptive pills as well as among obese people.

• Use of oral contraceptives^[7]

• Hyperhomocysteinemia:^[8] Hyperhomocysteinemia can be reduced with vitamin B supplementation.

• Advanced age
• Heart failure
• Thrombophilia or hypercoagulable state
  • Factor V Leiden
  • Prothrombin G20210A mutation
  • Protein C deficiency
  • Protein S deficiency
  • Antithrombin deficiency
  • Activated protein C resistance
  • Antithrombin III deficiency
  • Factor VIII mutation
  • Antiphospholipid syndrome
  • Heparin induced thrombocytopenia
  • Nephrotic syndrome
  • Paroxysmal nocturnal hemoglobinuria
• Polycythemia vera

• Pregnancy and the peri-partum period
• Active cancer
• Central venous catheter

Other possible factors associated with VTE include:

• Nutrition low in fish, fruits, and vegetables^[9]
• Psychological stress^[10]
• Cardiovascular risk factors such as diabetes and hypercholesterolemia^[11]
• Acute medical illness
• Drug abuse (intravenous drugs)^[12]
• Sickle cell disease^[13]
• Inflammatory bowel disease^[14]
• Antipsychotic drugs^[15]
• Thrombocytosis^[16]
• Varicose veins^[17][18]

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