High Thrombotic Risk Patient Identification
Stroke and Immobility-Related Risk Factors
- Patients with a history of immobility, cancer, previous thromboembolism, and specific genetic or acquired thrombophilias are at high risk of thrombosis, according to the International Journal of Stroke guidelines 1, 2
- Patients unable to move one or both lower limbs are at high risk of thrombosis, as stated by the International Journal of Stroke 1, 2
- Patients with previous history of venous thromboembolism are at high risk of thrombosis, as reported by the International Journal of Stroke 1, 2
- Dehydration is a risk factor for thrombosis, as noted by the International Journal of Stroke 1, 2
- Comorbidities such as cancer increase the risk of thrombosis, as stated by the International Journal of Stroke and the Journal of the National Comprehensive Cancer Network 1, 2, 3
Cancer-Related Risk Factors
- Patients with advanced disease of the brain, lung, uterus, bladder, pancreas, stomach, and kidney have the highest 1-year incidence rate of venous thromboembolism (VTE), as reported by the Journal of the National Comprehensive Cancer Network and Annals of Oncology 3, 4
- Metastatic disease increases VTE risk 4-13 times compared to localized disease, according to Annals of Oncology 4
- The Khorana score identifies high-risk ambulatory cancer patients based on cancer site, pre-chemotherapy platelet count, hemoglobin, leukocyte count, and BMI, as stated by Annals of Oncology 4
- High-risk patients (score ≥3) have a 6.7% incidence of VTE, as reported by Annals of Oncology 4
- For multiple myeloma patients receiving immunomodulatory drugs, specific risk assessment models (SAVED or IMPEDE VTE) are recommended by the Journal of the National Comprehensive Cancer Network 5
Genetic and Acquired Thrombophilias
- Factor V Leiden mutation is the most common genetic cause of thrombophilia, as stated by Stroke 6, 7
- Prothrombin G20210A mutation is the second most common genetic cause of thrombophilia, according to Stroke 6, 7
- Antiphospholipid syndrome is the most common acquired cause of thrombophilia, as reported by Stroke 6, 7
- Deficiencies of coagulation inhibitors (antithrombin III, protein C, or protein S) increase the risk of thrombosis, as noted by Stroke 6, 7
- Homozygous factor V Leiden carriers have significantly higher risk than heterozygous carriers, as stated by Stroke 6, 7
Cardiovascular and Cerebrovascular Risk Factors
- Patients with mechanical heart valves, especially older caged-ball valves, are at high risk of thrombosis, as reported by Blood 8
- Patients with non-valvular atrial fibrillation with high CHADS₂ scores (5-6) are at high risk of thrombosis, according to Blood 8
- Patients with suspected cardioembolic stroke mechanism are at high risk of thrombosis, as stated by the International Journal of Stroke 1, 9
- Patients with patent foramen ovale and cryptogenic stroke have an increased risk of paradoxical embolism, as noted by Stroke 6, 7
Perioperative and Procedural Risk
- Major surgery and laparoscopic procedures with pneumoperitoneum and reverse Trendelenburg position increase the risk of thrombosis, as reported by Blood 8
- Major cardiovascular surgery, orthopedic surgery, head and neck cancer surgery, and urologic surgery increase the risk of thrombosis, according to Blood 8
- Surgeries lasting ≥45 minutes increase the risk of thrombosis, as stated by Blood 8
Special Populations
- Patients with myeloproliferative neoplasms, particularly polycythemia vera, have a high prevalence of thrombosis, as reported by the Journal of the National Comprehensive Cancer Network 5
Risk Stratification Approach
- For stroke patients, assessing mobility status, previous VTE history, and comorbidities is recommended by the International Journal of Stroke 1, 2
- For cancer patients, using validated risk assessment models (Khorana score, SAVED, IMPEDE VTE) is recommended by Annals of Oncology and the Journal of the National Comprehensive Cancer Network 4, 5
- For surgical patients, considering procedure type, duration, and patient-specific factors is recommended by Blood 8
- For patients with atrial fibrillation, using the CHADS₂ score is recommended by Blood 8