Резюме
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- inflamación de las pantorrillas
- dolor o sensibilidad a lo largo del sistema venoso profundo
- dolor torácico
- taquipnea
- dificultad para respirar
- hipotensión
- taquicardia
Other diagnostic factors
- antecedentes familiares de tromboembolia venosa (TEV)
Risk factors
- antecedentes de tromboembolia venosa no provocada
- mayor edad
- embarazo/posparto
- obesidad
- tabaquismo
- neoplasia maligna
- estado inflamatorio agudo
- anticuerpos antifosfolípidos (AAF)
- enfermedades mieloproliferativas
- síndrome nefrótico
- enfermedad de Behcet
- Infección por VIH
- coagulación intravascular diseminada
- hemoglobinuria paroxística nocturna
- trombocitopenia inducida por heparina
- Píldora anticonceptiva oral que contiene estrógenos/tratamiento de sustitución hormonal/tratamiento con moduladores selectivos de los receptores de estrógenos
- quimioterapia
- cirugía
- vuelo de largo recorrido (>4 horas)
- deficiencia de antitrombina
- deficiencia de proteína C
- deficiencia de proteína S
- deficiencia de plasminógeno
- fibrinógeno elevado
- disfibrinogenemia
- factor V de Leiden
- mutación del gen de la protrombina (G-20210-A; también denominada variante F2 c.*97G>A)
- niveles elevados del factor VIII (>150 U/L)
- niveles elevados del factor IX o XI
- hiperhomocisteinemia
- anemia falciforme
- niveles elevados del inhibidor de la fibrinólisis activado por la trombina (IFAT)
Diagnostic investigations
1st investigations to order
- hemograma completo (HC)
- frotis de sangre periférica
- tiempo de tromboplastina parcial activada (TTPa)
- fibrinógeno
- tiempo de protrombina (TP)
- dímero D
- albúmina sérica
- creatinina sérica
- colesterol sérico
- triglicéridos séricos
Investigations to consider
- prueba de trombofilia hereditaria
- reacción en cadena de la polimerasa (PCR) para el factor V Leiden
- anticuerpos antifosfolípidos (anticoagulante lúpico, anticuerpos anticardiolipina, anticuerpos antibeta-2 glicoproteína 1)
- nivel de homocisteína
- nivel de factor VIII
- panel de neoplasias mieloproliferativas
- citometría de flujo para hemoglobinuria paroxística nocturna
- prueba de trombocitopenia inducida por heparina (TIH)
- radiografía de tórax
- tomografía computarizada (TC) del abdomen
- ultrasonido de abdomen
- marcadores tumorales
- recolección de orina de 24 horas para analizar el nivel de proteínas o muestras puntuales de orina para evaluar la relación proteína/creatinina
Treatment algorithm
no embarazadas: sin cáncer y con una enfermedad médica aguda
no embarazada: con cáncer
no embarazadas: sometidas a cirugía no ortopédica
no embarazadas: sometidas a una cirugía ortopédica
no embarazadas con un traumatismo importante
embarazadas
Contributors
Authors
Lara N. Roberts, MBBS, MD (Res), FRCP, FRCPath
Consultant Haematologist
King's Thrombosis Centre
King's College Hospital
London
UK
Disclosures
LNR has received speaker fees from Bayer and Viatris.
Roopen Arya, BMBCh (Oxon), MA, PhD, FRCP, FRCPath
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
Beverly Hunt, FRCP, FRCPath, MD
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.
Per Morten Sandset, MD, PhD
Senior Consultant and Head of Department
Oslo University Hospital Ullevål
Department of Hematology
Professor in Hematology
University of Oslo
Oslo
Norway
Disclosures
PMS declares that he has no competing interests.
Michael Bromberg, MD, PhD
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e691S-736S.Full text Abstract
American College of Chest Physicians. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST. 2012;141(suppl 2):e1S-801S.Full text
Arachchillage DJ, Mackillop L, Chandratheva A, et al. Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 2022 Aug;198(3):443-58.Full text Abstract
Anderson DR, Morgano GP, Bennett C, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019 Dec 10;3(23):3898-944.Full text Abstract
Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline Update. J Clin Oncol. 2023 Jun 1;41(16):3063-71.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease
- Venous thromboembolism prophylaxis and treatment in patients with cancer: clinical practice guideline update
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