What are the risk factors for extensive femoral vein thrombosis (Deep Vein Thrombosis, DVT)?

From the Guidelines

Risk factors for extensive femoral vein thrombosis include advanced age, obesity, prolonged immobility, recent surgery, trauma, cancer, pregnancy, use of estrogen-containing medications, and inherited thrombophilias, with cancer being a significant independent risk factor, as noted in a study published in the Journal of Thrombosis and Haemostasis 1.

Key Risk Factors

• Advanced age
• Obesity
• Prolonged immobility
• Recent surgery, especially orthopedic procedures
• Trauma
• Cancer
• Pregnancy
• Use of estrogen-containing medications
• Inherited thrombophilias, such as Factor V Leiden mutation or Protein C/S deficiency These risk factors can contribute to hypercoagulability, and identifying them is crucial for implementing appropriate prophylactic measures in high-risk patients.

Additional Considerations

• Medical conditions, including heart failure, inflammatory bowel disease, nephrotic syndrome, and myeloproliferative disorders, also contribute to hypercoagulability, as mentioned in a guideline published in Blood Advances 1.
• Acute medical illnesses requiring hospitalization, particularly with ICU admission, elevate risk due to immobility and inflammatory states.
• Central venous catheters placed in the femoral vein can directly damage the vessel wall, triggering clot formation.
• Dehydration increases blood viscosity, while smoking damages endothelial cells and promotes thrombosis.

Prophylactic Measures

Implementing appropriate prophylactic measures in high-risk patients is crucial, including:

• Early mobilization
• Mechanical prophylaxis with compression devices
• Pharmacological prophylaxis with low molecular weight heparin, unfractionated heparin, or direct oral anticoagulants when indicated, as recommended by the American Society of Hematology 1.

From the FDA Drug Label

In the EINSTEIN DVT and EINSTEIN PE studies, 49% of patients had an idiopathic DVT/PE at baseline 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%), or active cancer (5%) In the EINSTEIN CHOICE study, 51% of patients had DVT only, 33% had PE only, and 16% had PE and DVT combined 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%), or active cancer (3%)

The risk factors for extensive femoral vein thrombosis (Deep Vein Thrombosis, DVT) include:

• Idiopathic DVT/PE: 49% of patients in the EINSTEIN DVT and EINSTEIN PE studies
• Previous episode of DVT/PE: 19% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 17% in the EINSTEIN CHOICE study
• Recent surgery or trauma: 18% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 12% in the EINSTEIN CHOICE study
• Immobilization: 16% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 10% in the EINSTEIN CHOICE study
• Use of estrogen-containing drugs: 8% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 5% in the EINSTEIN CHOICE study
• Known thrombophilic conditions: 6% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 6% in the EINSTEIN CHOICE study
• Active cancer: 5% of patients in the EINSTEIN DVT and EINSTEIN PE studies, 3% in the EINSTEIN CHOICE study
• Factor V Leiden gene mutation: 4% of patients in the EINSTEIN CHOICE study 2 2

From the Research

Risk Factors for Extensive Femoral Vein Thrombosis (Deep Vein Thrombosis, DVT)

The risk factors for extensive femoral vein thrombosis (DVT) include:

• Hereditary thrombophilia, such as Factor V Leiden (FVL) 3
• Surgery and trauma 3, 4
• Hospital or nursing home confinement 4
• Malignant neoplasm with or without chemotherapy 4
• Central venous catheter or pacemaker 4
• Superficial vein thrombosis 4
• Neurological disease with extremity paresis 4
• Varicose veins, although the risk diminishes with age 4
• Prolonged periods of immobility, and aging 5
• Autoimmune diseases, and thrombophilia 6
• Inflammatory bowel disease, and paralysis 5
• Sepsis 5

Clinical Risk Factors

Clinical risk factors for VTE, which includes DVT, include:

• Cancer 5, 4
• Major trauma 5, 4
• Surgery 3, 5, 4
• Sepsis 5
• Inflammatory bowel disease 5
• Paralysis 5
• Prolonged periods of immobility 5
• Aging 5

Hypercoagulability

Hypercoagulability, which can be caused by hereditary thrombophilia such as FVL, increases the risk of developing VTE, including DVT 3