From the Guidelines
Thrombosis is primarily caused by a combination of genetic and acquired factors, including hypercoagulability, blood vessel damage, and abnormal blood flow, with specific risk factors such as antithrombin deficiency, protein C deficiency, factor V Leiden, and external factors like trauma, surgery, immobilization, and malignancy. The causes of thrombosis can be categorized into primary and secondary factors 1. Primary factors include genetic mutations such as antithrombin deficiency, protein C deficiency, factor V Leiden, and hyperhomocysteinemia, which lead to hypercoagulability 1. Secondary factors, on the other hand, include external factors like trauma, surgery, immobilization, malignancy, and central venous catheters, which can cause blood vessel damage and abnormal blood flow 1. Some specific risk factors for thrombosis include:
- Advanced age
- Obesity
- Smoking
- Pregnancy and postpartum period
- Oral contraceptives and hormone replacement therapy
- Malignancy and chemotherapy
- Immobilization and long distance travel
- Chronic venous insufficiency and heart failure
- Nephrotic syndrome and hyperviscosity
- Platelet abnormalities and prosthetic surfaces The location of thrombosis also plays a crucial role, with most thromboemboli arising from the inferior vena cava, particularly in the femoral and iliac veins 1. Prevention and management of thrombosis should focus on addressing modifiable risk factors, such as regular exercise, smoking cessation, weight management, and appropriate anticoagulation therapy when indicated 1. In high-risk situations like surgery or prolonged bed rest, prophylactic anticoagulants such as low molecular weight heparin, compression stockings, or early mobilization may be recommended to prevent thrombosis formation 1.
From the FDA Drug Label
Heparin-induced thrombocytopenia (HIT) is a serious antibody-mediated reaction. HIT occurs in patients treated with heparin and is due to the development of antibodies to a platelet Factor 4-heparin complex that induce in vivo platelet aggregation HIT may progress to the development of venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia with thrombosis (HITT). Thrombotic events may also be the initial presentation for HITT These serious thromboembolic events include deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, limb ischemia, stroke, myocardial infarction, mesenteric thrombosis, renal arterial thrombosis, skin necrosis, gangrene of the extremities that may lead to amputation, and possibly death
The causes of thrombosis include heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT), which can lead to various thromboembolic events such as:
- Deep vein thrombosis
- Pulmonary embolism
- Cerebral vein thrombosis
- Limb ischemia
- Stroke
- Myocardial infarction
- Mesenteric thrombosis
- Renal arterial thrombosis
- Skin necrosis
- Gangrene of the extremities 2
From the Research
Causes of Thrombosis
- Thrombosis is a complex condition with multiple causes, including genetic and acquired risk factors 3
- Acquired risk factors for venous thrombosis include advanced age, prolonged immobilization, surgery, fractures, use of oral contraceptives and hormone replacement therapy, pregnancy, puerperium, cancer, and antiphospholipid syndrome 3
- Genetic risk factors for venous thrombosis include mutations in the genes that encode antithrombin, protein C and protein S, and the factor V Leiden and factor II G20210 A mutations 3
- Plasmatic risk indicators, such as hyperhomocysteinemia and elevated concentrations of factors II, VIII, IX, XI, and fibrinogen, have also been documented as causes of thrombosis 3
Risk Factors in Cancer Patients
- Cancer patients are at increased risk of developing venous thromboembolism (VTE) due to various factors, including tumor type, stage, and treatment 4, 5, 6, 7
- Historically significant risk factors for VTE in cancer patients, such as high platelet count, high leukocyte count, low hemoglobin level, and high-risk gastrointestinal, genitourinary, and lung cancers, may not be significantly associated with the risk of VTE recurrence 6
- The use of direct oral anticoagulants (DOACs) such as rivaroxaban has been shown to be effective and safe in treating cancer-associated VTE, with similar efficacy and safety profiles compared to low molecular weight heparins (LMWHs) 4, 6, 7
Treatment and Prevention
- The treatment and prevention of thrombosis involve the use of anticoagulants, such as LMWHs and DOACs, to reduce the risk of VTE recurrence and bleeding complications 4, 5, 6, 7
- The choice of anticoagulant therapy depends on various factors, including the patient's underlying condition, renal function, and bleeding risk 4, 6, 7