From the Guidelines
Deep vein thrombosis (DVT) risk factors include both acquired and inherited conditions, with major acquired risk factors being prolonged immobility, recent surgery, trauma, hospitalization, active cancer, pregnancy, postpartum state, hormone therapy, advanced age, obesity, and smoking, as noted in the 2021 American Society of Hematology guidelines 1.
Acquired Risk Factors
- Prolonged immobility
- Recent surgery (especially orthopedic)
- Trauma
- Hospitalization
- Active cancer
- Pregnancy
- Postpartum state
- Hormone therapy (including oral contraceptives and hormone replacement therapy)
- Advanced age
- Obesity
- Smoking
- Medical conditions like heart failure, inflammatory bowel disease, nephrotic syndrome, and myeloproliferative disorders
- Previous DVT or pulmonary embolism
Inherited Risk Factors
- Factor V Leiden mutation
- Prothrombin gene mutation
- Protein C deficiency
- Protein S deficiency
- Antithrombin deficiency
Other Risk Factors
- Central venous catheters and other indwelling devices can cause local clot formation
- Dehydration contributes by increasing blood viscosity
- The risk of DVT increases substantially when multiple risk factors are present simultaneously, as they have a cumulative effect, as discussed in the 2020 guidelines for management of venous thromboembolism 1.
Prevention Strategies
- Early mobilization after surgery
- Appropriate anticoagulation prophylaxis in high-risk situations
- Compression stockings
- Lifestyle modifications like maintaining healthy weight and avoiding smoking
- The Khorana VTE risk assessment model for cancer patients may be utilized in the ambulatory setting, as mentioned in the 2017 article on cardiovascular complications of cancer therapy 1.
From the FDA Drug Label
In the EINSTEIN CHOICE study, other risk factors included:
- Idiopathic VTE (43%)
- Previous episode of DVT/PE (17%)
- Recent surgery or trauma (12%)
- Prolonged immobilization (10%)
- Use of estrogen containing drugs (5%)
- Known thrombophilic conditions (6%)
- Factor V Leiden gene mutation (4%)
- Active cancer (3%) In the EINSTEIN DVT and EINSTEIN PE studies, other risk factors included:
- Previous episode of DVT/PE (19%)
- Recent surgery or trauma (18%)
- Immobilization (16%)
- Use of estrogen-containing drug (8%)
- Known thrombophilic conditions (6%)
- Active cancer (5%)
The risk factors for DVT mentioned in the drug label are:
- Idiopathic VTE
- Previous episode of DVT/PE
- Recent surgery or trauma
- Prolonged immobilization
- Use of estrogen containing drugs
- Known thrombophilic conditions
- Factor V Leiden gene mutation
- Active cancer 2 2
From the Research
Risk Factors for Deep Vein Thrombosis (DVT)
The risk factors for DVT can be categorized into acquired and inherited factors. According to 3, these factors increase the risk of VTE via several common mechanisms including circulatory stasis, endothelial damage, or increased hypercoagulability.
- Acquired risk factors:
- Age: The incidence of DVT varies with age, with the elderly being more likely to have comorbidities such as diabetes and malignancies 4
- Immobility: Prolonged bed rest or immobility can increase the risk of DVT
- Surgery: Major surgery, especially orthopedic surgery, can increase the risk of DVT
- Trauma: Major trauma, especially to the lower extremities, can increase the risk of DVT
- Cancer: Active cancer or a history of cancer can increase the risk of DVT
- Anticoagulation noncompliance: Noncompliance with anticoagulant therapy can increase the risk of recurrent DVT 4
- Inherited risk factors:
- Factor V Leiden: A mutation in the factor V gene that increases the risk of DVT 5, 6, 7
- Prothrombin G20210A mutation: A mutation in the prothrombin gene that increases the risk of DVT 5
- Deficiencies of antithrombin, protein C, and protein S: These deficiencies can increase the risk of DVT 5
- Thrombomodulin gene mutations: Mutations in the thrombomodulin gene, such as the G127-->A mutation, can increase the risk of DVT 7
- Genetic risk score (GRS): A high GRS can indicate an increased risk of DVT 5
Special Considerations
- Pregnancy: Pregnancy can increase the risk of DVT, especially in women with a history of DVT or inherited thrombophilia 7
- Autoimmune diseases: Certain autoimmune diseases, such as lupus, can increase the risk of DVT 4
- Congenital risk factors: Congenital risk factors, such as congenital heart disease, can increase the risk of DVT 4