Thrombosis

Keywords: Thromboembolism

Key Information

Appropriate Tests

 

See Thrombophilia

Arterial

Most instances of arterial thromboembolism are due to abnormalities in the vessel wall and/or blood flow. Evidence does not support routine testing for the ‘thrombophilic’ factors associated with venous thrombosis.

Embolic

 

Cardiac/valvular

  • Mural thrombus
  • Prosthetic valve
  • Endocarditis

 

Aorta/proximal artery

  • Atheromatous plaque
  • Thrombus

 

Local thrombosis

  • Atherosclerotic arterial disease
  • Aneurysm
  • Vasculitis
  • Local trauma

 

Predisposing abnormalities

 

Abnormal vascular surface

 

  • Atherosclerosis

See Cardiac risk assessment.

  • Prosthetic valve

 

Abnormal/turbulent blood flow

  • Hypertension
  • Prosthetic valve
  • Arrhythmias

 

Blood abnormalities

 

  • Phospholipid antibody syndrome

APTT, Lupus anticoagulant; Cardiolipin Ab.

  • Myeloproliferative neoplasms
    • Polycythaemia vera
    • Essential thrombocythaemia

Full blood count

  • Paraproteinaemia

 

  • Heparin-induced thrombocytopenia

Full blood count

  • PNH
 
  • Homocysteinaemia

Homocysteine; testing for mutations of methyl tetra hydrofolate reductase (MTHFR) gene.

Venous

 

Predisposing abnormalities

 

Abnormal blood flow

 

Venous stasis

  • Immobilisation
  • Cardiac failure
  • Varicose veins
  • Pregnancy

 

Vein wall injury/disease

  • Pelvic, hip surgery
  • Pelvic carcinoma

 

Blood abnormalities:

Investigation may be indicated when venous thromboembolism is unexplained or recurrent; occurs in unusual sites; occurs in a young patient, or in a patient with a positive family history.

Acquired blood abnormalities

 

  • Phospholipid antibody syndrome

APTT, Lupus inhibitor, Cardiolipin Ab.

  • Myeloproliferative neoplasms
    • Polycythaemia vera
    • Essential thrombocythaemia

Full blood count.

  • Antithrombin deficiency

Antithrombin assay.

  • Pregnancy

See also Venous stasis, above.

  • Oestrogen therapy

 

  • Nephrotic syndrome

 

  • Paraproteinaemia

 

  • Protein C deficiency

 

  • Liver disease

 

  • Loading dose of oral anticoagulants

Patients with pre-existing protein C deficiency are at particular risk.

  • Heparin-induced thrombocytopenia
Full blood count, HITT's antibody screen and confirmatory testing.

Inherited blood abnormalities

 

  • Factor V variant (V Leiden)

APC resistance, Molecular genetics - genetic disorders - Factor V Leiden mutation.

  • Antithrombin deficiency

Antithrombin assay.

  • Protein C deficiency

Protein C, Protein S assays.

  • Protein S deficiency

Protein C, Protein S assays.

  • Prothrombin gene mutation (G20210A)

Molecular genetics - genetic disorders; Prothrombin gene mutation.

  • Dysfibrinogenaemia

Thrombin time, Reptilase time. For further investigation - consult haematopathologist.

  • Activated protein C resistance

APC resistance

Superficial thrombophlebitis

 

Cellulitis

 

Malignancy

 

Carcinoma

  • Lung
  • Pancreas
  • Gastrointestinal tract