It most commonly affects leg veins, such as the femoral vein. Three factors are important in the formation of a blood clot within a deep vein—these are the rate of blood flow, the thickness of the blood and qualities of the vessel wall. The condition usually comes to light after vigorous exercise and usually presents in younger, otherwise healthy people. Men are affected more than women. Budd-Chiari syndrome is the blockage of a hepatic vein or of the hepatic part of the inferior vena cava. This form of thrombosis presents with abdominal pain, ascites and enlarged liver. Portal vein thrombosis affects the hepatic portal vein, which can lead to portal hypertension and reduction of the blood supply to the liver. Renal vein thrombosis is the obstruction of the renal vein by a thrombus. This tends to lead to reduced drainage from the kidney. Jugular vein thrombosis is a condition that may occur due to infection, intravenous drug use or malignancy.
Jugular vein thrombosis can have a varying list of complications, including: systemic sepsis, pulmonary embolism, and papilledema. Cavernous sinus thrombosis is a specialised form of cerebral venous sinus thrombosis, where there is thrombosis of the cavernous sinus of the basal skull dura, due to the retrograde spread of infection and endothelial damage from the danger triangle of the face. Arterial thrombosis is the formation of a thrombus within an artery. Arterial embolism occurs when clots then migrate downstream, and can affect any organ. The most common cause is atrial fibrillation, which causes a blood stasis within the atria with easy thrombus formation, but blood clots can develop inside the heart for other reasons too. A stroke is the rapid decline of brain function due to a disturbance in the supply of blood to the brain.
A lesion is then formed which is the infarct. An arterial thrombus or embolus can also form in the limbs, which can lead to acute limb ischemia. Hepatic artery thrombosis usually occurs as a devastating complication after liver transplantation. Thrombosis prevention is initiated with assessing the risk for its development. Some people have a higher risk of developing thrombosis and its possible development into thromboembolism. Some of these risk factors are related to inflammation. The main causes of thrombosis are given in Virchow’s triad which lists thrombophilia, endothelial cell injury, and disturbed blood flow. Hypercoagulability or thrombophilia, is caused by, for example, genetic deficiencies or autoimmune disorders. Recent studies indicate that white blood cells play a pivotal role in deep vein thrombosis, mediating numerous pro-thrombotic actions.
Any inflammatory process, such as trauma, surgery or infection, can cause damage to the endothelial lining of the vessel’s wall. The main mechanism is exposure of tissue factor to the blood coagulation system. Endothelial injury is almost invariably involved in the formation of thrombi in arteries, as high rates of blood flow normally hinder clot formation. Causes of disturbed blood flow include stagnation of blood flow past the point of injury, or venous stasis which may occur in heart failure, or after long periods of sedentary behaviour, such as sitting on a long airplane flight. Fibrinolysis is the physiological breakdown of blood clots by enzymes such as plasmin. Organisation: following the thrombotic event, residual vascular thrombus will be re-organised histologically with several possible outcomes. Venous thrombosis can lead to pulmonary embolism when the migrated embolus becomes lodged in the lung.
The tissue can become irreversibly damaged, a process known as necrosis. The use of heparin following surgery is common if there are no issues with bleeding. Generally, a risk-benefit analysis is required, as all anticoagulants lead to an increased risk of bleeding. In people admitted to hospital, thrombosis is a major cause for complications and occasionally death. The treatment for thrombosis depends on whether it is in a vein or an artery, the impact on the person, and the risk of complications from treatment. Warfarin and vitamin K antagonists are anticoagulants that can be taken orally to reduce thromboembolic occurrence. Thrombolysis is the pharmacological destruction of blood clots by administering thrombolytic drugs including recombitant tissue plasminogen activator, which enhances the normal destruction of blood clots by the body’s enzymes. Arterial thrombosis may require surgery if it causes acute limb ischemia.
Mechanical clot retrieval and catheter-guided thrombolysis are used in certain situations. Arterial thrombosis is platelet-rich, and inhibition of platelet aggregation with antiplatelet drugs such as aspirin may reduce the risk of recurrence or progression. In Kasper DL, Braunwald E, Fauci AS, et al. Causes and predictors of death in cerebral venous thrombosis”. Medicine Article on Internal Jugular Vein Thrombosis by Dale K. Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors”. The role of leukocytes in thrombosis”.
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