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0:00
Ladies and gentlemen,
it gives me pleasure
and an honor to
present to you on the topic of
venous thromboembolism
and its management.
0:12
First of all, a few words
about the epidemiology.
Deep vein thrombosis encompasses
the deep veins in
the legs, the arms,
but also in unusual
sites of thrombosis
such as the splanchnic
veins, the cerebral veins,
and sinuses or renal veins.
And then we have pulmonary
embolism as well.
The incidence is
variable depending
on how well you have
investigated the population,
so between 104 and 183
per 100000 person-years.
The higher number is if
you have performed autopsy
on the suspected fatal events.
There is an ethnic variability,
with the Black race
having a higher incidence
than the White or
Caucasian race,
and those in turn have
a higher incidence
than people from Asia.
Slightly higher
incidence among males
compared to females, and
there is a clear age effect
with an almost exponential
increase with age.
Although there is also a
small bump at the early age,
so there are cases with
neonatal thrombosis.
1:31
The etiology of venous
thromboembolism can be split up
into three entities, which
we call Virchow's triad.
Virchow was a
pathologist in Germany,
who was interested in
the study of veins.
On the left upper, you
see reduced blood flow,
which can happen if the
patient is immobilized,
or if you have some
obstruction inside the vein,
such as a catheter.
You can also have
reduced blood flow
if there is something
compressing
the vein from outside,
such as a tumor.
On the upper right,
you see changes in
the vessel wall,
and that occurs, for instance,
if there is an injury
during surgery
or a trauma that
involves the veins,
or when there is
slow blood flow,
the leukocytes, the
white blood cells,
tend to adhere to
the endothelium
and release enzymes that
can damage the endothelium.
Finally, at the bottom,
you see changes in the
blood composition,
which we see with inflammatory
reaction or cancer.
There is an increase
in fibrinogen and
some other coagulation factors.
There is a concentration
of blood cells in cancer,
specifically, there is C protein
that can directly
activate factor X,
which is one of the
coagulation factors.
And in dehydration,
there is a concentration of
the components in the blood
increasing the risk
of thrombosis.
