Summary
Definition
History and exam
Key diagnostic factors
- calf swelling
- pain or tenderness along deep venous system
- chest pain
- tachypnea
- breathlessness
- hypotension
- tachycardia
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
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
Treatment algorithm
Contributors
Authors VIEW ALL
Consultant Haematologist
King's Thrombosis Centre
King's College Hospital
London
UK
Disclosures
LNR declares that she has no competing interests.
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.
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