What are the causes of Venous Thromboembolism (VTE)?

As part of World Thrombosis Day 2018 we will be joining the campaign to spread awareness about VTE, the most common cause of hospital related deaths, with informative articles explaining its causes, treatment and prevention methodologies. 
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Venous thromboembolism (VTE) is a complex vascular disease that encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE).  A DVT develops most commonly in the deep veins of the calf, thigh and pelvis and becomes symptomatic when the clot limits blood flow.  A more serious condition is pulmonary embolism (PE) where part of or all of the thrombus in the limb breaks off and enters the pulmonary arterial circulation, occluding blood flow to the lungs. If the embolism is large, it can be fatal. Most usually, VTE develop as a result of illness or surgery associated with immobility.  VTE formation although complex, consists of three primary risk factors collectively referred to as Virchow’s Triad, namely Venous Stasis, Hypercoagulation and vessel injury.1

Venous stasis and VTE

Situations which lead to the slowing of blood flow (stasis) can increase the potential of VTE occurring.  Immobility is a clear risk factor in relation to venous stasis. When one or more risk factors are present anyone from a new mother to a frail elder with reduced mobility is at risk2.

Surgery itself can pose challenges as practitioners balance the need for muscle relaxants with the prevention of venous stasis3.

Hypercoagulation as a risk factor

Excessive blood clotting, or Hypercoagulation is a recognised risk factor when it comes to VTE.2 There are both acquired and genetic reasons for excessive blood clotting. Being a smoker, being overweight or obese all increase the level of risk. The use of birth control pills or hormone replacement therapy can also increase the risk of developing the condition.2

Vessel injury & VTE risk

When a person experiences vascular trauma they are at heightened risk of developing VTE. Vessel injury can occur because of a physical accident or injury. It may also be connected to a surgical procedure or central venous catheterisation. Those with varicose veins have an elevated risk of developing the condition, as do people who have previously been diagnosed with Deep Vein Thrombosis (DVT).5

VTE causes, prevention and non-invasive treatments

Surgical inpatients are at an increased risk of VTE4, due to surgery itself posing the greatest risk; anaesthetics, muscle relaxants and vessel damage during surgical intervention heightening this risk3.

It is now clear that non-surgical patients are also at high risk of VTE. Awareness of the need for prophylaxis in high risk groups such as critical care, cancer, obstetrics, bariatrics, stroke and older paediatric patients has been steadily increasing over recent years.

VTE has recognised causes. There are also  effective interventions that help to minimise risk.

For more information on VTE and its causes, prevention and treatments using non-invasive/non-pharma solutions, please download the Clinical Evidence Summary - Preventing Venous Thromboembolism with Intermittent Pneumatic Compression.

Download VTE Evidence Brochure

References

 

  1. International consensus document (2013) Prevention and Treatment of Venous Thromboembolism
  2. Reitsma PH, Versteeg HH, Middeldorp S. Mechanistic view of risk factors for venous thromboembolism. Arteriosclerosis, thrombosis and vascular biology. 2012; 32(3): 563-8.
  3. Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004; 126(suppl 3): 338-400S
  4. Nicolaides A, Fareed J, Kakkar A et al. Prevention and treatment of venous thromboembolism - International Consensus Statement. International Angiology. 2013; 32(2): 111-260.
  5. Beckman MG, Hooper WC, Critchley SE et al. Venous thromboembolism: a public health concern. Am J Prev Med. 2010; 38(4): S495-501