Epidemiology
Venous thrombosis has one incidence occurs at on annual incidence of about 1 on 1000 adult persons (1/1000).
The incidence increase considerably after the 45 years of age and is highter in man than women in older age.
Other factors of risk are the exogenous factors such as surgery, hospitalization,
immobility, trauma, pregnancy, the puerperium and hormone use, endogenous factors such as cancer, obesity, inherited and acquired disorders of hypercoagulation.
Thrombosis to charactherize the type of pathology
Definition of pathology
This thrombosis is a pathology or pathological process that is originated for haemostatic increasing and altered activity.
This pathological process door the formation of a semi-solid mass (thrombus) present in the venous system ( venous thrombosis ) to low pressure and bottom flow and in the arterial system (arterial thrombosis) to high flow and high pressure , the perturbation of the haemostasis to the base of the thrombosis to be caused from factor factors acclimatizes them and from genetic factors.
DEFINITION
This thrombosis is a pathology or pathological process that is originated for haemostatic increasing and altered activity.
This pathological process door the formation of a semi-solid mass (thrombus) present in the venous system ( venous thrombosis ) to low pressure and bottom flow and in the arterial system (arterial thrombosis) to high flow and high pressure , the perturbation of the haemostasis to the base of the thrombosis to be caused from factor factors acclimatizes them and from genetic factors.
The disease definition according to the specific consensus conference.
EPIDEMIOLOGY
age, sex, seasonality, etc
SYMPTOMS
DIAGNOSIS
histopathology
radiology
NMR
laboratory tests
PATIENT RISK FACTORS
Obesità e fumo fattori di rischio tromboembolici
Tra i principali fattori di rischio cardiovascolare, soltanto l'obesità e l'abitudine al fumo sono importanti anche come elementi predisponenti al tromboembolismo venoso (Vte). Lo rivelano i risultati di uno studio prospettico di coorte condotto dal 1976 al 2007 su un campione randomizzato di abitanti in una definita area di Copenhagen stratificati per età. La prima diagnosi di trombosi venosa profonda o embolismo polmonare è stata recuperata dai registri nazionali elettronici dalla baseline fino al termine dello studio. Su 18.954 soggetti studiati con un follow-up mediano di 19,5 anni, 969 sono andati incontro ad almeno 1 episodio di Vte, corrispondente a un tasso crudo di incidenza di 2,69 per 1.000 persone/anno. Utilizzando un modello multivariato con correzioni per età e periodo di osservazione, si sono rivelate significativamente associate al Vte le seguenti variabili: indice di massa corporea (Hr per >/=35 vs. <20 = 2,10), fumo (Hr per >/=25 g di tabacco al giorno vs. mai fumatore= 1,52%), genere (Hr per uomini vs. donne = 1,24), reddito familiare (Hr per medio vs. basso = 0,82) e pressione arteriosa diastolica (Hr per > 100 vs. <80 mmHg = 1,34). Altri fattori di rischio cardiovascolare, tra i quali i livelli di colesterolo totale, Hdl e Ldl, dei trigliceridi e il diabete mellito non sono invece apparsi associati al Vte.
Circulation, 2010;121:1896-1903
Vascular
Genetic
Acquired
Hormonal
Genetic
Acquired
TISSUE SPECIFIC RISK FACTORS
anatomical (due its structure)
vascular (due to the local circulation)
physiopathological (due to tissue function and activity)
COMPLICATIONS
Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. 2010
Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. 2011
OBJECTIVE: To determine the effect of sex on the risk of recurrent venous thromboembolism in all patients and in patients with venous thromboembolism that was unprovoked or provoked (by non-hormonal factors). Data source Comprehensive search of electronic databases (Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials) until July 2010, supplemented by review of conference abstracts and contact with content experts.
STUDY SELECTION: Seven prospective studies investigating an association between D-dimer, measured after anticoagulation was stopped, and disease recurrence in patients with venous thromboembolism.
DATA EXTRACTION: Patient level databases were obtained, transferred to a central database, checked, and completed with further information provided by authors.
DATA SYNTHESIS: 2554 patients with a first venous thromboembolism had follow-up for a mean of 27.1 (SD 19.6) months. The one year incidence of recurrent venous thromboembolism was 5.3% (95% confidence interval 4.1% to 6.7%) in women and 9.5% (7.9% to 11.4%) in men, and the three year incidence of recurrence was 9.1% (7.3% to 11.3%) in women and 19.7% (16.5% to 23.4%) in men. Among patients with unprovoked venous thromboembolism, men had a higher risk of recurrence than did women (hazard ratio 2.2, 95% confidence interval 1.7 to 2.8). After adjustment for women with hormone associated initial venous thromboembolism, the risk of recurrence remained higher in men (hazard ratio 1.8, 1.4 to 2.5). In patients with provoked venous thromboembolism, occurring after exposure to a major risk factor, recurrence of disease did not differ between men and women (hazard ratio 1.2, 0.6 to 2.4). In women with hormone associated venous thromboembolism and no other risk factors, recurrence was lower than that in women with unprovoked venous thromboembolism and no previous hormone use (hazard ratio 0.5, 0.3 to 0.8).
CONCLUSION: In patients with a first unprovoked venous thromboembolism, men have a 2.2-fold higher risk of recurrent venous thromboembolism than do women, which remained 1.8-fold higher in men after adjustment for previous hormone associated venous thromboembolism in women. In patients with a first provoked venous thromboembolism, risk of recurrence does not differ between men and women with or without hormone associated venous thromboembolism. Indefinite anticoagulation may be given greater consideration in men than in women after a first venous thromboembolism.
