Does vaping increase the risk of Deep Vein Thrombosis (DVT)?

Vaping and the Risk of Deep Vein Thrombosis

Vaping significantly increases the risk of deep vein thrombosis (DVT) by causing platelet hyperactivation, enhancing thrombogenesis, and shortening thrombosis occlusion time. 1, 2

Mechanisms by which vaping increases DVT risk

• E-cigarette exposure causes hyperactivation of platelets with enhanced aggregation, dense and α granule secretion, and activation of the αIIbβ3 integrin 2
• Vaping leads to increased phosphatidylserine expression and Akt and ERK activation in platelets compared to clean air exposure 2
• JUUL e-cigarettes specifically have been shown to shorten thrombus occlusion time and hemostasis/bleeding times in experimental models 1
• E-cigarette-exposed platelets become resistant to inhibition by prostacyclin, which normally helps prevent inappropriate clotting 2

Experimental evidence

• In controlled studies, mice exposed to e-cigarette vapor for just 2 weeks (70 puffs daily) showed significantly shortened thrombosis occlusion times compared to clean air exposure (medians of 14 vs. 200 seconds) 1
• Hemostasis/bleeding times were also dramatically shortened (35 vs. 295 seconds), indicating increased thrombotic risk 1
• Even short-term e-cigarette exposure alters physiological hemostasis and increases thrombogenesis risk 2

Risk factors that may compound vaping-related DVT risk

• Age over 60 years (OR 1.34) 3
• Immobility, defined as confinement to bed for >72 hours or being bedridden (OR 3.17) 3
• History of heart failure (OR 2.68) 3
• History of previous VTE (OR 6.08) 3
• Active malignancy (OR 2.65) 3
• Critical illness requiring ICU or CCU stay (OR 1.65) 3
• Infections including cellulitis, pneumonia, and sepsis (OR 1.48) 3
• Elevated C-reactive protein >10 mg/L (OR 10.10) 3

Clinical implications

• The perception that e-cigarettes are "safer" than conventional cigarettes may be misleading when considering thrombotic risk 2
• The negative cardiovascular effects of vaping should not be underestimated, particularly in patients with other risk factors for DVT 1
• Patients who vape and develop unexplained leg pain, swelling, or redness should be evaluated for possible DVT 3
• Healthcare providers should consider vaping as a potential risk factor when assessing a patient's overall risk for venous thromboembolism 3

Prevention strategies

• Patients should be educated about the increased risk of thrombotic events associated with vaping 1, 2
• Those with multiple risk factors for DVT should be strongly advised to discontinue vaping 3
• For long-distance travelers who vape, additional preventive measures may be warranted, such as frequent movement, proper hydration, and consideration of compression stockings 3

Caveat

• While older research (1978) suggested smoking might have a protective effect against DVT 4, more recent and methodologically robust studies have demonstrated that nicotine delivery systems, including e-cigarettes, increase thrombotic risk 1, 2
• The thrombotic risk of vaping appears to be related to its effects on platelet function rather than other mechanisms 2