TAILIEUCHUNG - Chapter 059. Bleeding and Thrombosis (Part 7)

The most important point in a history related to venous thrombosis is whether the thrombotic event was idiopathic (meaning there was no clear precipitating factor) or was a precipitated event. In patients without underlying malignancy, having an idiopathic event is the strongest predictor of recurrence of venous thromboembolism. In patients who have a vague history of thrombosis, a history of being treated with warfarin suggests a past DVT. Age is an important risk factor for venous thrombosis; the risk of DVT increases per decade, with an approximate incidence of 1/100,000 per year in early childhood to 1/200 per year. | Chapter 059. Bleeding and Thrombosis Part 7 The most important point in a history related to venous thrombosis is whether the thrombotic event was idiopathic meaning there was no clear precipitating factor or was a precipitated event. In patients without underlying malignancy having an idiopathic event is the strongest predictor of recurrence of venous thromboembolism. In patients who have a vague history of thrombosis a history of being treated with warfarin suggests a past DVT. Age is an important risk factor for venous thrombosis the risk of DVT increases per decade with an approximate incidence of 1 100 000 per year in early childhood to 1 200 per year among octogenarians. Family history is helpful in determining if there is a genetic predisposition and how strong that predisposition appears to be. A genetic thrombophilia that confers a relatively small increased risk such as being a heterozygote for the prothrombin G20210A or factor V Leiden mutation may be a relatively minor determinant of risk in an elderly individual undergoing a high risk surgical procedure. As shown in Fig. 59-5 a thrombotic event often has more than one contributing factor. Predisposing factors must be carefully assessed to determine the risk of recurrent thrombosis and with consideration of the patient s bleeding risk determine the length of anticoagulation. Similar consideration should be given to determining the need to test the patient and family members for genetic thrombophilias. Figure 59-5 Thrombotic risk over time. Shown schematically is an individual s thrombotic risk over time. An underlying Factor V Leiden mutation provides a theoretically constant increased risk. The thrombotic risk increases with age and intermittently with oral contraceptive OCP or hormone replacement HRT use other events may increase the risk further. At some point the cumulative risk may increase to the threshold for thrombosis and result in deep venous thrombosis DVT . Note The magnitude and duration of

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