Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • pain or tenderness along deep venous system
  • chest pain
  • tachypnea
  • breathlessness
  • hypotension
  • tachycardia

Other diagnostic factors

  • family history of VTE

Risk factors

  • hx of unprovoked venous thromboembolism
  • increasing age
  • pregnancy/postpartum
  • obesity
  • smoking
  • malignancy
  • acute inflammatory state
  • antiphospholipid antibodies
  • myeloproliferative disorders
  • nephrotic syndrome
  • Behcet disease
  • HIV infection
  • disseminated intravascular coagulation
  • paroxysmal nocturnal hemoglobinuria
  • heparin-induced thrombocytopenia
  • estrogen-containing oral birth control pills/HRT/selective estrogen receptor modulator therapy
  • chemotherapy
  • surgery
  • long-haul flight (>4 hours)
  • antithrombin deficiency
  • protein C deficiency
  • protein S deficiency
  • plasminogen deficiency
  • elevated fibrinogen
  • dysfibrinogenemia
  • factor V Leiden
  • prothrombin gene mutation (G-20210-A)
  • elevated factor VIII levels (>150 U/L)
  • elevated levels of factor IX or XI
  • hyperhomocysteinemia
  • sickle cell disease
  • elevated levels of thrombin-activatable fibrinolysis inhibitor (TAFI)

Diagnostic investigations

1st investigations to order

  • CBC
  • peripheral blood smear
  • activated partial thromboplastin time
  • fibrinogen
  • prothrombin time
  • D-dimer
  • serum albumin
  • serum creatinine
  • serum cholesterol
  • serum triglycerides
Full details

Investigations to consider

  • thrombophilia test
  • PCR for factor V Leiden
  • lupus anticoagulant and anticardiolipin antibodies
  • homocysteine level
  • factor VIII level
  • PCR for JAK2 mutation
  • flow cytometry for paroxysmal nocturnal hemoglobinuria
  • heparin-induced thrombocytopenia test
  • chest x-ray
  • abdominal CT
  • abdominal ultrasound
  • tumor markers
  • 24-hour urine collection for protein, or spot urine for protein/creatinine ratio
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Lara N. Roberts

Consultant Haematologist

King's Thrombosis Centre

King's College Hospital

London

UK

Disclosures

LNR declares that she has no competing interests.

Roopen Arya

Professor of Thrombosis and Haemostasis

King's Thrombosis Centre

King's College NHS Foundation Trust

London

UK

Disclosures

RA declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Thrombosis & Haemostasis

King's College

Consultant

Departments of Haematology, Pathology & Rheumatology

Lead in Blood Sciences

Guy's & St Thomas' NHS Foundation Trust

London

UK

Disclosures

BH declares that she has no competing interests.

Senior Consultant and Head of Department

Oslo University Hospital Ullevål

Department of Hematology

Professor in Hematology

University of Oslo

Oslo

Norway

Disclosures

PMS is an author of one reference cited in this monograph.

Associate Professor

Director of Hematologic Malignancies

Medicine and Pharmacology

Temple University School of Medicine

Philadelphia

PA

Disclosures

MB declares that he has no competing interests.

Use of this content is subject to our disclaimer