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Causes of Deep Vein Thrombosis (DVT)

Causes of DVT affect one or more of the 3 components of Virchow’s triad (Stasis, hypercoagulable states and injury):

Stasis of blood

  • Immobility
    • e.g. from hospital admission or plaster cast
  • Proximal compression of veins
    • e.g. from inguinal lymphadenopathy, ovarian tumour or cervical rib

Hypercoagulable state

  • Acquired
    • Inflammation
      • Following trauma or surgery
      • Post-partum
      • Malignancy
      • Acute inflammatory (e.g. IBD) or infectious illness
    • Organ dysfunction
      • Liver disease
      • Renal failure
      • Nephrotic syndrome
    • Haematological
      • Anti-phospholipid syndrome
      • Hyperviscosity due to leukocytosis (>100), or high levels of IgM or IgA paraprotein
      • Myeloproliferative disorders (polycythaemia rubra vera, essential thrombocythaemia, myelofibrosis)
      • Paroxysmal nocturnal haemoglobinuria
      • ITP and heparin-induced thrombocytopenia (HIT)
    • Drugs
      • Oral contraceptives and hormone replacement therapy
      • Glucocorticoids
      • Thalidomide and its derivatives
  • Congenital
    • Antithrombin deficiency
    • Protein C and Protein S deficiency
    • Prothrombin G20210A
    • Factor V Leiden (activated protein C resistance)
    • Note much inherited risk is due to numerous unidentified polymorphisms in other genes

Endothelial injury

  • Recreational intravenous drug use
  • Iatrogenic central venous catheters
  • Surgery

Other

  • Obesity
    • Not¬†clearly in any part of Vichow’s triad, but may be related to both inflammation and statis

 

To guide clinical management it is helpful to divide risk factors into reversible (e.g. trauma, acute inflammation) and irreversible (e.g inoperable cancer, genetic factors), then focus on modifying the reversible factors.

 

Now click here to learn about the investigation and treatment of DVT

…or here for exam questions on DVT

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