Causes of Provoked Pulmonary Embolism

Strong Risk Factors

The European Society of Cardiology recommends that major orthopedic surgery, particularly hip or knee replacement, is a strong risk factor for provoking PE, with the highest risk in the first 2 postoperative weeks but remains elevated for 2-3 months 1, 4
Major trauma, including lower limb fractures, is a strong risk factor for provoking PE, according to the British Thoracic Society 2, 5
The American Heart Association states that hospitalization for heart failure or atrial fibrillation is a strong risk factor for provoking PE 3
Myocardial infarction is a strong risk factor for provoking PE, as recommended by the European Society of Cardiology 1, 6
Spinal cord injury is a strong risk factor for provoking PE, according to the British Thoracic Society 2, 3

Active malignancy, particularly cancers of the uterus, pancreas, breast, stomach, and metastatic disease, is a moderate risk factor for provoking PE, as stated by the British Thoracic Society 2
Chemotherapy is a moderate risk factor for provoking PE, according to the European Respiratory Society 6, 3
Central venous catheters are a moderate risk factor for provoking PE, although upper extremity clots rarely cause fatal PE, as recommended by the British Thoracic Society 2, 6
Autoimmune diseases are a moderate risk factor for provoking PE, as stated by the European Society of Cardiology 3
Hormone replacement therapy is a moderate risk factor for provoking PE, with risk varying widely depending on formulation used, according to the European Respiratory Society 6

Prolonged immobilization, including bed rest and lower limb immobility from stroke, is a weak risk factor for provoking PE, as recommended by the British Thoracic Society 2, 5
Obesity is a weak risk factor for provoking PE, according to the European Society of Cardiology 1, 2
Pregnancy and early puerperium, especially with operative delivery, is a weak risk factor for provoking PE, as stated by the British Thoracic Society 2
Oral contraceptives are a weak risk factor for provoking PE, with current low-dose formulations carrying lower risk than older preparations, according to the British Thoracic Society 2
Advanced age, greater than 40 years, with risk doubling each decade, is a weak risk factor for provoking PE, as recommended by the European Society of Cardiology 1, 4
Diabetes mellitus, arterial hypertension, and hypercholesterolemia are weak risk factors for provoking PE, according to the European Society of Cardiology 1, 6

The European Society of Cardiology states that the risk of VTE is highest during the first 2 postoperative weeks but remains elevated for 2-3 months after major surgery, particularly in surgical patients 1, 4
The British Thoracic Society recommends that multiple risk factors dramatically increase PE risk through additive effects, especially in medical inpatients 2
The European Respiratory Society states that serious chronic medical conditions and central venous lines are the primary triggers for PE in pediatric patients 1, 6, 7

The majority of symptomatic DVT involves proximal clots, which lead to PE in 40-50% of cases, often without clinical manifestations, as recommended by the European Society of Cardiology 1, 4
Cardiovascular risk factors, such as smoking, obesity, hypercholesterolemia, hypertension, and diabetes, may represent indirect associations mediated through coronary artery disease complications rather than direct PE triggers, according to the European Society of Cardiology 1, 6, 3
Occult malignancy should be considered in patients presenting with unprovoked PE or recurrent PE, as stated by the British Thoracic Society 5
Failure to rapidly achieve therapeutic anticoagulation levels independently predicts early recurrence, as recommended by the European Society of Cardiology 1