Thrombosis: Prevention

To prevent thrombosis, attention must be paid to reducing individual risk factors.

Behavioral risk factors

• Diet
  • Inadequate fluid intake – causes the body to become dehydrated (esiccosis) and increases the tendency to clot
  • Micronutrient deficiency (vital substances) – see prevention with micronutrients.
• Drug use
  • Cocaine
• Recreational drug use
  • Tobacco (smoking)
• Physical activity
  • Postpartum
  • Frequent, prolonged sitting; “travel thrombosis” at a desk.
  • Long-haul flights (flight travel time > 6 hrs; “economy-class syndrome”).
  • Immobility
• Overweight (BMI ≥ 25; obesity) – obesity from a BMI (body mass index) > 30 – 230% increase in risk due to increase in clotting and inhibition of fibrinolysis (inhibition of the dissolution of blood clots).

Drugs

• Antidepressants (amitriptyline/in patients > 70 L. J).
• Antipsychotics (neuroleptics) – chlorpromazine, clozapine, haloperidol, thioridazine.
• Diuretics [exsiccosis]
• Hormones
  • Glucocorticoids (budenoside, cortisone, fluticasone, prednisolone).
  • Estrogens (ethinyl estradiol, estradiol) – estrogen therapy as hormone replacement therapy (HT): increase in thromboembolic risk by: + 6 events per 10,000 women per year of use.
  • Estrogen-progestin combinations (oral contraceptives: ethinyl estradiol + norethisterone / norgestrel derivative – esp. in combination with smoking; hormone replacement therapy, HRT) in menopause: increase in thromboembolic risk by: + 17 events per 10,000 women per year of use.
• See also under “Thromboembolism by drugs“; progestins combined with ethinyl estradiol, here show esp. the following progestins: gestodene / desogrestrel / drospirenone, etonogestrel / norelgestromin an increased risk of thromboembolism.

Other risk factors

• Bed confinement, e.g., after surgery (e.g., cesarean section) or severe illness.
• Pregnancy – from the first weeks of pregnancy to about six weeks postpartum (after delivery), thromboembolism, i.e., deep vein thrombosis and pulmonary embolism or cerebral thrombosis, is up to ten times more common than outside this time period; in weeks 7 to 12, the risk of thrombosis is still increased by a factor of 2.2
• Trauma (injury):
  • Head 54 %
  • Pelvic fractures (pelvic fractures) 61 %.
  • Tibia fractures (fractures of the tibia) 77%.
  • Femur fractures (fractures of the femur) 80%.

Primary prophylaxis of venous thromboembolism (VTE) [Guideline: 1]

• Primary prophylaxis in ambulatory oncology patients:
  • NMH (low molecular weight heparin):
    • In outpatients with locally advanced or metastatic pancreatic cancer receiving systemic tumor therapy; requirement: low risk of bleeding.
    • In prophylactic dosing in patients receiving immunomodulatory therapy in combination with systemic steroids or other systemic tumor therapies; also here vitamin K antagonists (VKA) or acetylsalicylic acid in low or therapeutic doses
  • Direct oral anticoagulants (DOAK):
    • Rivaroxaban and apixaban in patients undergoing systemic tumor therapy with moderate to high risk of VTE (by tumor type or clinical risk score); requirement: without active bleeding or high risk of bleeding.