Mechanisms of Fever in Deep Vein Thrombosis
Deep vein thrombosis (DVT) can cause fever primarily through inflammatory processes that are intrinsically linked to thrombogenesis and through potential infectious complications. 1, 2
Inflammatory Mechanisms
DVT triggers a significant inflammatory response as part of the thrombotic process, with cross-talk between the innate immune system and coagulation cascade driving both clot formation and fever 1
Endothelial activation occurs during DVT formation, leading to the release of pro-inflammatory cytokines that can trigger fever as part of the systemic inflammatory response 3
The interaction between activated platelets, leukocytes, and endothelial cells during thrombosis creates an inflammatory environment that can elevate body temperature 4
Neutrophil extracellular traps (NETs) formation during DVT contributes to both clot formation and systemic inflammation that may manifest as fever 1
Hypoxia and reactive oxygen species generated in the thrombotic process activate inflammasomes, which release pyrogenic cytokines 1
Clinical Significance of Fever in DVT
Approximately 4.9% of patients with DVT present with fever at diagnosis, indicating it's a relatively common finding 2
Patients with DVT who present with fever have a significantly higher mortality rate (5.8% vs 2.9%) compared to those without fever 2
Fever in DVT patients is associated with a 2-fold increased risk of death (hazard ratio: 2.00) independent of age, body weight, and other risk factors for venous thromboembolism 2
Potential Complications Leading to Fever
Pulmonary embolism (PE), a common complication of DVT, can cause fever and is more common in DVT patients who present with fever (0.7% vs 0.1%) 2
Infectious complications are significantly more common causes of death in DVT patients presenting with fever (1.1% vs 0.3%) 2
Superficial vein thrombosis (SVT), which can occur simultaneously with DVT, presents with more obvious inflammatory signs including pain, erythema, and tenderness that may be accompanied by fever 5
Relationship Between DVT and Infection
Infection and DVT can coexist, with each condition potentially exacerbating the other 2
Catheter-associated thrombosis, particularly with peripherally inserted central catheters (PICCs), can be associated with infusion thrombophlebitis which may present with fever 5
PICC-related superficial vein thrombosis occurs in approximately 29% of hospitalized patients requiring intravenous therapy for more than 5 days, and may be accompanied by fever 5
Clinical Implications
Fever in a patient with DVT should prompt evaluation for potential complications such as pulmonary embolism or infection 2
The presence of fever in DVT carries prognostic significance, with worse outcomes reported in these patients 2
Understanding the inflammatory nature of DVT provides potential therapeutic targets that may address both thrombosis and its inflammatory manifestations including fever 1, 4