Pathophysiology

The formation of venous clots is related to at least one of Virchow's triad of factors: venous stasis, injury to vessel wall, and hypercoagulable state. T§b!e,..5.5.-I outlines the clinical risk factors predisposing to DVT, which can be remembered by the mnemonic thrombosis; T.a.bIe,,5.5.-2. provides a detailed list of associated conditions. Trauma includes multitrauma patients, lower extremity fractures, and burns. Hypercoagulable states include those associated with malignancy; lupus anticoagulant; deficiency of or resistance to protein C, protein S, or antithrombin III; and abnormal plasminogen or plasminogen activators, all of which can lead to clotting. Obstetric risk occurs not only during pregnancy but also in the postpartum period. Medications that predispose to thrombosis include birth control pills and replacement hormones. Major orthopedic, thoracic, abdominal, or gynecologic surgery is a significant risk factor for developing DVT, though the risk is diminished with prophylactic subcutaneous heparin postoperatively. Illness includes cardiovascular diseases—myocardial infarction (MI), congestive heart failure (CHF), and cerebrovascular accident (CVA)—nephrotic syndrome, inflammatory bowel disease, and vasculitis (lupus, Behçet syndrome).

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Dealing With Back Pain

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