Summary
Definition
History and exam
Key diagnostic factors
- tromboembolismo venoso prévio, trombofilia, malignidade, quadro pós-operatório, trauma e cateter de demora central
- afecções clínicas crônicas, paresia, idade avançada, obesidade, pílulas contraceptivas contendo estrogênio e terapia de reposição hormonal, veias varicosas, gravidez e pós-parto de até 6 semanas, parente de primeiro grau com história de tromboembolismo venoso, viagens prolongadas e internação em unidade de terapia intensiva
Risk factors
- tromboembolismo venoso prévio (trombose venosa profunda (TVP) e/ou embolia pulmonar (EP))
- trombofilia
- neoplasia maligna
- quadro pós-operatório
- trauma
- cateter de demora central (membro superior ou inferior)
- imobilidade
- doenças mieloproliferativas
- insuficiência cardíaca congestiva
- doença pulmonar obstrutiva crônica
- doença inflamatória intestinal (DII)
- doença neurológica com paresia de membro
- idade mais avançada
- obesidade
- pílulas anticoncepcionais contendo estrogênio, terapia de reposição hormonal (TRH) e terapia de privação androgênica
- história de veias varicosas
- gestação/pós-parto
- viagens longas
- imobilidade da perna
- parente de primeiro grau com história de tromboembolismo venoso
- internação em unidade de terapia intensiva
Diagnostic investigations
1st investigations to order
- Hemograma completo
- creatinina sérica
- razão normalizada internacional (INR)
- tempo de tromboplastina parcial (TTP)
Investigations to consider
- anticorpos anti-fator 4 plaquetário séricos
Treatment algorithm
todos os pacientes com risco
pacientes com trauma
pacientes cirúrgicos
pacientes com afecções não cirúrgicas
Contributors
Authors
Anna L. Parks, MD
Assistant Professor
Division of Hematology
University of Utah
Salt Lake City
UT
Disclosures
ALP declares that she has no competing interests.
Acknowledgements
Dr Anna L. Parks would like to gratefully acknowledge Dr Nathalie Routhier, Dr Vicky Tagalakis, Dr Farah Zarka, Dr Vincent Bouchard-Dechêne, and Dr Adi J. Klil-Drori, previous contributors to this topic.
Disclosures
NR, FZ, VBD, and AJKD declare no competing interests. VT has received honoraria from BMS Pfizer and Bayer. She has developed educational materials for Thrombosis Canada. VT is an author of references cited in this topic.
Peer reviewers
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Sudeep Shivakumar, MD
Hematologist
Thrombosis Fellow
University of Ottawa
Ottawa Health Research Institute
Ottawa
Canada
Disclosures
SS 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
Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(suppl 2):e227S-77S.Full text Abstract
Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e278S-325.Full text Abstract
Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141 (2 Suppl):e195S-226S.Full text Abstract
National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Aug 2019 [internet publication].Full text
Nicolaides AN, Fareed J, Spyropoulos AC, et al. Prevention and management of venous thromboembolism. International consensus statement (guidelines according to scientific evidence). Int Angiol. 2024 Feb;43(1):1-222.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
- Clinical practice guidelines for the reduction of venous thromboembolic disease in colorectal surgery
More GuidelinesPatient information
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Trombose venosa profunda
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