VENOUS THROMBOSIS

Patients who experience venous thrombosis are usually found to have an explanation in one or more of the features of Virchow’s Triad. Surgery patients have stasis, vascular injury and frequently, hypercoagulability. Patients with idiopathic venous thrombophilic disease are found to have underlying disorders of thrombosis in as many as 80% of cases. While acute management is not usually impacted by the nature of the underlying cause, subacute and chronic management clearly requires a precise etiologic diagnosis. A thorough clinical and laboratory evaluation is required to make a specific diagnosis. Disorders frequently associated with venous thrombophilic disease include: Activated protein C resistance (including factor V Leiden mutation and factor V Cambridge mutation); Prothrombin G20210A mutation, Protein S and C deficiency, Antithrombin deficiency; Antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant), Hyperhomocysteinemia (methylene tetrahydrofolate reductase mutation C677T), Myeloproliferative disorders, Trousseau’s Syndrome, Sticky Platelet Syndrome, Wein Penzing platelet defect, Dysfibrinogenemia, Factor XII deficiency (Hageman factor), Heparin co-factor II defect, Plasminogen deficiency, Tissue –plasminogen activator deficiency, Plasminogen activator inhibitor Type-1 elevation, and von Willebrand’s factor elevation.

Risk Factors for Venous Thrombosis

• Orthopedic surgery, including arthroscopy
• Trauma
• Malignancy
• General surgery
• Immobility
• Sepsis
• Left ventricular failure
• Nephrotic syndrome
• Obesity
• Varicose veins
• Post-phlebitic syndrome
• Oral contraceptives
• Estrogen
• Pregnancy
• Puerperium