Preface

Venous thromboembolism (VTE) is a common disease with an incidence of over 1 in 1000 in Western countries. It is associated with significant morbidities and costs. Postthrombotic syndrome may develop in one third of patients with deep vein thrombosis (DVT) with considerable socio-economic consequences. DVT is usually seen in patients with underlying risk factors and patients undergoing major pelvic and orthopaedic surgeries. Numerous guidelines suggest use of DVT thromboprophylaxis in these patients, but despite encouraging results of thromboprophylaxis, many studies showed low compliance rates with such guidelines. Also in regions with low DVT prevalence, the benefit of pharmacological prophylaxis is not clear. Patients undergoing laporoscopic operations are also at risks of VTE because of increased venous stasis caused by abdominal insufflation and prolonged reverse Trendelenburg position. Most DVT occur in the lower limbs, but DVT the arms may account for 5% of VTE cases. Cancer and its treatment are recognized risk factors for VTE and extended prophylaxis in ambulatory cancer patients may be required. Recent radiological advances have facilitated the diagnosis and management of DVT and have also identified vena cava malformations as a new etiologic factor in young DVT patients. Endovascular therapy is a potential treatment option in acute DVT. Chronic liver disease is recently recognised as a hypercoagulable state. All this issues will be addressed by various experts in this book.

> **Dr. Gregory Cheng**  Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong

**1** 

 *Ankara, Turkey* 

**Risk Factors of Deep Vein Thrombosis** 

*Ankara University School of Medicine, Department of Cardiovascular Surgery,* 

Deep vein thrombosis is a clinical challenge for doctors of all disciplines. It can complicate the course of a disease but might also be encountered in the absence of precipitating disorders. Thrombosis can take place in any section of the venous system, but arises most frequently in the deep veins of the leg. Long-term morbidity due to post-thrombotic syndrome is common and can be substantial. The major concern, however, is embolisation of the thrombus to the lung, which can be fatal. Deep vein thrombosis is highly prevalent and poses a burden on health economy. The disorder and its sequelae are also among the best examples of preventable diseases. Relevant data for the frequency of deep vein thrombosis derive from large community-based studies because they mainly reflect symptomatic rather than asymptomatic disease. In a systematic review, the incidence of first deep vein thrombosis in the general population was 0·5 per 1000 person-years.1 The disorder is rare in children younger than 15 years,2,3 but its frequency increases with age, with incidence per 1000 person-years of 1·8 at age 65–69 years and 3·1 at age 85–89 years.4 Two-thirds of first-time episodes of deep vein thrombosis are caused by risk factors, including surgery, cancer, immobilisation, or admission for other reasons.5,6 Risk for first deep vein thrombosis seems to be slightly higher in men than in women.6,9 In a populationbased cohort study, the age-adjusted incidence of first venous thromboembolism was 1·3 per 1000 person-years in men and 1·1 per 1000 person-years in women.2 It is noteworthy

that the risk for recurrence of this disorder is higher in men than in women.6,10

Acute medical illnesses – eg, acute myocardial infarction, heart failure, respiratory failure,

Conditions associated with increased risk for deep vein thrombosis

**1. Introduction** 

Advancing age

Previous venous thromboembolism

Inflammatory bowel disease

Obesity

Surgery Trauma Active cancer

infection

Mustafa Sirlak, Mustafa Bahadir Inan, Demir Cetintas and Evren Ozcinar
