Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- inchaço da panturrilha
- dor ou sensibilidade ao longo do sistema venoso profundo
- dor torácica
- taquipneia
- dispneia
- hipotensão
- taquicardia
Other diagnostic factors
- histórico familiar de tromboembolismo venoso
Risk factors
- história de tromboembolismo venoso não provocado
- avanço da idade
- gestação/pós-parto
- obesidade
- tabagismo
- neoplasia maligna
- estado inflamatório agudo
- anticorpos antifosfolipídeos (AFLs)
- doenças mieloproliferativas
- síndrome nefrótica
- Doença de Behçet
- Infecção pelo vírus da imunodeficiência humana (HIV)
- coagulação intravascular disseminada
- hemoglobinúria paroxística noturna
- trombocitopenia induzida por heparina
- terapia com pílula contraceptiva oral contendo estrogênio/terapia de reposição hormonal (TRH)/terapia com modulador seletivo dos receptores estrogênicos
- quimioterapia
- cirurgia
- voos longos (>4 horas)
- deficiência de antitrombina
- deficiência de proteína C
- deficiência de proteína S
- deficiência de plasminogênio
- fibrinogênio elevado
- disfibrinogenemia
- fator V de Leiden
- Mutação no gene da protrombina (G-20210-A; também conhecido como variante F2 c.*97G>A).
- níveis elevados de fator VIII (>150 U/L)
- níveis elevados dos fatores IX ou XI
- hiper-homocisteinemia
- doença falciforme
- níveis elevados do inibidor de fibrinólise ativável por trombina (TAFI)
Diagnostic tests
1st tests to order
- Hemograma completo
- esfregaço de sangue periférico
- tempo de tromboplastina parcial ativada (TTPa)
- fibrinogênio
- tempo de protrombina (TP)
- dímero D
- albumina sérica
- creatinina sérica
- colesterol sérico
- triglicerídeos séricos
Tests to consider
- teste para trombofilia hereditária
- reação em cadeia da polimerase para fator V de Leiden
- anticorpos antifosfolipídeos (anticoagulante lúpico, anticorpos anticardiolipina, anticorpos anti-beta-2 glicoproteína 1)
- nível de homocisteína
- nível do fator VIII
- painel de neoplasia mieloproliferativa
- citometria de fluxo para hemoglobinúria paroxística noturna
- teste para trombocitopenia induzida por heparina (TIH)
- radiografia torácica
- tomografia computadorizada (TC) abdominal
- ultrassonografia abdominal
- marcadores tumorais
- coleta de urina de 24 horas para proteína ou amostra de urina para proporção proteína/creatinina urinária
Treatment algorithm
não gestante: sem câncer e com afecção clínica aguda
não gestante: com câncer
não gestante: submetido a cirurgia não ortopédica
não gestante: submetido a cirurgia ortopédica
não gestantes com trauma maior
gestante
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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