Major Risk Factors for Venous
Thrombosis
Mary Cushman, MD
Department of Medicine
Division of Hematology-Oncology
Outline
Risk factors for VTE
Modifiable Risk Factors
– Obesity
Non-Modifiable Risk Factors
– Genetic
Interventions
– Perso...
CLOT
Genetic Predisposition
Obesity
Pregnancy
Contraceptives
HRT/SERMS
Immobility Trauma or
Surgery Cancer
VTE Risk
Factor...
Obesity and VTE
BMI > 30 associated with 2 to 2.5-fold increased risk
– Risk higher with BMI >40
Abdollahi Thromb Haemost ...
19961991
Obesity Trends* Among U.S. Adults
BRFSS, 1991, 1996, 2004
(*BMI ≥30, or about 30 lbs overweight for 5’4” person)
...
Obesity Impact
Obesity in the US, age 45-64
1990 46.3M people 10% obese
2000 62 M people 25% obese
Obesity Impact
Obesity in the US, age 45-64
1990 46.3M people 10% obese
18,500 cases among obese
2000 62 M people 25% obes...
Obesity Impact
If only 10% were obese in 2000 we would
have 24,000 cases in this age group
1990 46.3M people 10% obese
18,...
Precise incidence unclear
Risk higher with
-prolonged trips
-oral contraceptives
-genetic predisposition
Air Travel and Th...
Genetic VTE Risk Factors
Coagulation CLOT Fibrinolysis
Factor V Leiden
Prothrombin 20210A
Antithrombin
Protein C
Protein S...
World Distribution of FVL
Zoller, Clin Appl Thromb Hemost 1997;3:25-32
VTE Risk Factor Model
Intrinsic
Thrombosis
Risk
Acquired RFsGene
s
++
VTE
Triggering
FactorsProphylaxis
+
–
Thrombosis
Thr...
How Can We Intervene?
Personal Level
– Public education, awareness of family history
– Weight loss
Health System Level
– N...
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  • These RFs all add together to enhance risk and it is most common that more than one of these is present in individuals affected by thrombosis
  • Powerpoint icon 2.1 MB

    1. 1. Major Risk Factors for Venous Thrombosis Mary Cushman, MD Department of Medicine Division of Hematology-Oncology
    2. 2. Outline Risk factors for VTE Modifiable Risk Factors – Obesity Non-Modifiable Risk Factors – Genetic Interventions – Personal level – Health System level
    3. 3. CLOT Genetic Predisposition Obesity Pregnancy Contraceptives HRT/SERMS Immobility Trauma or Surgery Cancer VTE Risk Factors Ornstein DL and Cushman, “Factor V Leiden”, Circulation 2003;107:e94-97 (http://lww.com) Age
    4. 4. Obesity and VTE BMI > 30 associated with 2 to 2.5-fold increased risk – Risk higher with BMI >40 Abdollahi Thromb Haemost 2003;89:493. Tsai M Arch Intern Med 2002;162:1182. – Reasons are unclear - ? physical factors with body size, coagulation factor changes Obesity risk adds to impact of other risk factors – Oral contraceptives: 2-3 10-fold with obesity – HRT: 2-3  6-fold with obesity Abdollahi Thromb Haemost 2003;89:493. Cushman JAMA 2004;292:1573. Why do we care so much?
    5. 5. 19961991 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2004 (*BMI ≥30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 2004 From CDC website
    6. 6. Obesity Impact Obesity in the US, age 45-64 1990 46.3M people 10% obese 2000 62 M people 25% obese
    7. 7. Obesity Impact Obesity in the US, age 45-64 1990 46.3M people 10% obese 18,500 cases among obese 2000 62 M people 25% obese 62,000 cases among obese
    8. 8. Obesity Impact If only 10% were obese in 2000 we would have 24,000 cases in this age group 1990 46.3M people 10% obese 18,500 cases among obese 2000 62 M people 25% obese 62,000 cases among obese
    9. 9. Precise incidence unclear Risk higher with -prolonged trips -oral contraceptives -genetic predisposition Air Travel and Thrombosis
    10. 10. Genetic VTE Risk Factors Coagulation CLOT Fibrinolysis Factor V Leiden Prothrombin 20210A Antithrombin Protein C Protein S Gain of Function Loss of Function ~35% of patients with thrombosis have one of these disorders
    11. 11. World Distribution of FVL Zoller, Clin Appl Thromb Hemost 1997;3:25-32
    12. 12. VTE Risk Factor Model Intrinsic Thrombosis Risk Acquired RFsGene s ++ VTE Triggering FactorsProphylaxis + – Thrombosis Threshold • Anticoagulant deficiencies • Factor V Leiden • Prothrombin 20210A • Age • Previous VTE • Cancer • Obesity • Varicose Veins • Hormone Treatments • Pregnancy • Surgery • Immobilization • Trauma • Air Travel
    13. 13. How Can We Intervene? Personal Level – Public education, awareness of family history – Weight loss Health System Level – National Promote education Promote thinning of America – Hospitals Implement prevention methods in high risk situations

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