Chapter 35
Thromboembolic Diseases
Virchow's triad drives clot formation
Venous Thromboembolic Disease (VTED)
VTED occurs when one or more elements of Virchow's triad are present, resulting in deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The triad is: vascular injury, venous stasis, and a hypercoagulable state (decreased protein C, protein S, or antithrombin). Annual VTE events exceed 600,000, with about 296,370 deaths.
Every risk factor for clotting maps onto one leg of Virchow's triad. Understanding the triad explains why surgery, immobility, and cancer all raise VTE risk.
Vascular injury
Surgery, trauma, central catheters
Venous stasis
Immobility, long travel, heart failure
Hypercoagulability
Low protein C/S, low antithrombin, factor V Leiden
DVT
Deep venous thrombosis (usually the leg)
PE
Pulmonary embolism -- can be fatal
Cancer/estrogen
Malignancy, oral contraceptives, HRT, SERMs
๐ โVTED = Virchow's triad (vascular injury, venous stasis, hypercoagulable state: low protein C/S or antithrombin) -> DVT and/or PE. >600,000 VTE events/year, ~296,370 deaths. Risk: surgery, trauma, immobility, malignancy, estrogen, age >40, pregnancy.โ