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Thrombosis

German: Thrombose

1 Definition

Thrombosis is defined as a localised, intravasal coagulation leading to the intravasal development of a thrombus, a blood clot inside the circulation system. A combination of causes can lead to this pathology, all described in the Virchow's triad.

2 Classification

Generally, thrombosis can occur in all blood vessels. Generally, a distinction is made between

Deep vein thrombosis is further described in three types:

  • Type 1: distal thrombosis, extending in proximal direction (most frequent).
  • Type 2: proximal thrombosis, extending to the distal segments
  • Type 3: thrombosis developing from superficial veins via vena perforantes to the deep veins.

Type 1 and type 2 usually have a lower risk of emboli; however it extends the more proximal the thrombus is situated.

3 Localisation

Venous thrombosis most often occurs in the leg veins. Here, either the deep veins (phlebothrombosis or the superficial veins (thrombophlebitis are affected leading to different clinical presentations.

Another possible localisation are the arm veins, especially in men after extensive use of arm and should muscles.

Arterial thrombosis is most often found in coronary arteries, brain arteries or leg arteries.

The thrombosis can either lead to a direct occlusion of the blood vessel, or via scattering of thrombotic material leading to emboli in the following segments of circulation.

4 Causes

There are multiple factors contributing to thrombosis, often in combination.

5 Clinical presentation

The clinical presentation of thrombosis vary with different localizations. Beside inflammation symptoms, pain, heaviness, muscular tiring can be symptoms.

The probability of a thrombotic event can be assessed with the Well's score.

6 Diagnosis

The diagnosis of thrombosis can be problematic. The most reliable technique is duplex sonography.

A good laboratory parameter for exclusion of thrombosis is D-dimer (if D-dimers are negative, thrombotic events can generally be excluded as a cause). However, this parameter is not very sensitive for proving a thrombosis.

7 Complications

The most frequent and most feared complication is thrombotic embolism, which leads to the occlusion of vessels at other localizations than the primary thrombotic event.

Most common complications for venous thrombosis:

Most common complications for arterial thrombosis

8 Therapy

Antithrombosis therapy depends on the extend and the localisation of the thrombosis. Anticoagulative medication such as heparin, lysis therapy, surgery etc. can be considered.

9 Prophylaxis

To prevent thrombosis, anticoagulation therapy is generally conducted.

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