Rudolf Virchow
Rudolf Ludwig Carl Virchow was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder of social medicine, and to his colleagues, the "Pope of medicine". He received the Copley M…
Endothelium
Endothelium refers to cells that line the interior surface of blood vessels and lymphatic vessels, forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall. It is a thin layer of simple, or single-layered, squamous cells called endothelial cells. Endothelial cells in direct contact with blood are called vascular endothelial cells, whereas those in direct contact wit…
Thrombophilia
Thrombophilia is an abnormality of blood coagulation that increases the risk of thrombosis. Such abnormalities can be identified in 50 per cent of people who have an episode of thrombosis that was not provoked by other causes. A significant proportion of the population has a detectable abnormality, but most of these only develop thrombosis in the presence of an additional risk factor.
Is Virchow's triad relevant in the setting of proximal venous insufficiency and DVT?
Objective: While determining the incidence of chronic deep vein thrombosis (DVT) and the hypercoagulation profiles of patients who underwent venous stenting for symptomatic venous insufficiency, we assessed the significance of Virchow's triad in the setting of proximal venous outflow obstruction and DVT.
What is the pathophysiology of venous thrombosis (DVT)?
The pathophysiology of venous thrombosis has been famously described by Rudolf Virchow, known as the Virchow's triad, which includes stasis, endothelial injury, and hypercoagulability. Venous thrombosis can be superficial venous thrombosis, or deep venous thrombosis (DVT), the latter will be the foc …
What is Virchow’s triad?
Virchow's triad consists of three factors that may predispose a person to the development of venous thrombosis. These factors include: Virchow's triad consists of three factors that may predispose a person to the development of venous thrombosis. These factors include: NCBI Skip to main content
What are the components of Virchow's triad of thrombosis?
One or more components of Virchow's triad (stasis, hypercoagulability, and venous injury), described more than 150 years ago, are present in nearly all patients. The risk increases with age. Idiopathic thromboembolism likely involves an underlying prothrombotic state that has not been characterized.
What is Virchows Triad?
Virchow's triad (venous stasis, vessel wall injury, and hypercoagulability) summarizes the mechanisms by which acquired and inherited risk factors (Table 10‐1) predispose to VTE. Typically, lower‐extremity thrombus develops in valve pockets of the calf veins.
What is the Virchow triad mark all that apply?
They are stasis, hypercoagulability, and vessel wall injury. These are commonly referred to as Virchow's triad.
What factors increase the risk of DVT?
Risk factors for DVT include:Age. Being older than 60 increases the risk of DVT . ... Lack of movement. ... Injury or surgery. ... Pregnancy. ... Birth control pills (oral contraceptives) or hormone replacement therapy. ... Being overweight or obese. ... Smoking. ... Cancer.More items...•
How do you assess Virchow's triad?
0:006:38Virchow's Triad Nursing Explanation (DVT Thrombosis) - YouTubeYouTubeStart of suggested clipEnd of suggested clipWell this includes the veins of the pelvic area the lower leg like the calf and the thighs. So theMoreWell this includes the veins of the pelvic area the lower leg like the calf and the thighs. So the specific veins are like the perineal. And the posterior tibial. And the calf's or a lower leg.
How does endothelial damage cause DVT?
Injury to endothelium is accompanied by loss of protective molecules and expression of adhesive molecules, procoagulant activities, and mitogenic factors, leading to development of thrombosis, smooth muscle cell migration, and proliferation and atherosclerosis.
How does venous stasis cause DVT?
Venous stasis syndrome related to DVT is due to venous outflow obstruction and venous valvular incompetence, while venous stasis syndrome related to older age and to varicose veins is due to venous outflow obstruction and to venous valvular incompetence, respectively.
Which of these is the most significant risk factor for DVT?
The most common risk factors include obesity, previous venous thromboembolism, cancer, surgery, trauma, and immobility.
What is the most common cause of DVT?
There are dozens of reasons why someone can get a blood clot that causes deep vein thrombosis, but some of the most common include blood vessel damage, inactivity, pregnancy, obesity and medical or genetic conditions. Damage to the wall of a blood vessel causes it to be much more narrow than normal.
Who is high risk for blood clots?
Blood clots can affect anyone at any age, but certain risk factors, such as surgery, hospitalization, pregnancy, cancer and some types of cancer treatments can increase risks. In addition, a family history of blood clots can increase a person's risk. The chance of a blood clot increases when you have more risk factors.
How is DVT diagnosis?
Duplex ultrasound. It's the standard test for diagnosing DVT . For the test, a care provider gently moves a small hand-held device (transducer) on the skin over the body area being studied. Additional ultrasounds may be done over several days to check for new blood clots or to see if an existing one is growing.
How does DVT turn into PE?
The most serious complication of DVT happens when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE). If the clot is small, and with appropriate treatment, people can recover from PE.
Which of the following characteristics is typical of the pain associated with DVT?
Typical symptoms of DVT include pain in a leg or hip, tenderness, tightness and red skin. The affected area may also swell and feel warm.
How is ad dimer test done?
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
What does D-dimer measure?
D-dimer tests are used to check for blood clotting problems. Blood clots can cause health problems, such as: Deep vein thrombosis (DVT) Pulmonary embolism (PE)
What are lines of Zahn?
Lines of Zahn are characteristic of thrombus formed at the site of rapid arterial blood flow, with laminations produced by successive deposition of platelets and fibrin (pale layers) alternating with red blood cells (dark layers).
What is D-dimer test in medical?
A D-dimer test is a blood test that measures D-dimer, which is a protein fragment that your body makes when a blood clot dissolves in your body. D-dimer is normally undetectable or only detectable at a very low level unless your body is forming and breaking down significant blood clots.
How does cardiac surgery affect Virchow's triad?
Cardiac Surgery. Cardiac surgery affects two arms of Virchow's triad via changes in blood flow and endothelial damage. In any cardiovascular procedure, endothelial damage results from even the smallest and most delicate intravascular sutures and manipulations.
What is Virchow's triad?
One or more components of Virchow's triad (stasis, hypercoagulability, and venous injury), described more than 150 years ago, are present in nearly all patients. The risk increases with age. Idiopathic thromboembolism likely involves an underlying prothrombotic state that has not been characterized. Deep vein thrombi frequently originate in the calf veins and propagate proximally to the popliteal vein or above before embolizing. Thrombosis developing in the axillary–subclavian veins due to the presence of a central venous catheter, particularly in patients with malignant disease, as well as in those with effort-induced upper extremity thrombosis may result in PE as well.
What are the factors that contribute to thrombosis?
In his eponymous triad, Virchow described the three categories of factors which contribute to thrombosis: hypercoagulability, haemodynamic changes (stasis, turbulence) and endothelial injury ( Figure 17.2 ). Pregnancy alone impacts significantly on Virchow’s triad. Pronounced increases in Factors I, V, VII, VIII, IX, X, XII, von Willebrand factor antigen and ristocetin co-factor activity engender a pro-thrombotic milieu [16–18]. Changes in the deep venous system also occur in normal pregnancy: a marked reduction in blood flow velocity accompanied by an increase in the diameter of the major leg veins together with the pressure of the gravid uterus lead to venous stasis [19,20]. Trauma to the venous system can occur in the course of vaginal delivery as the head passes through the pelvis. Such trauma is also a feature of operative delivery, whether abdominal or vaginal [21].
What are the hemostatic factors after a prosthetic heart valve replacement?
Hemostatic factors following prosthetic heart valve replacement involve adequacy and duration of antithrombotic treatment as well as the degree of hypercoagulability of patients. The early postoperative/postintervention period represents a challenge, with the need to balance the risks of excessive antithrombotic therapy and associated bleeding complications. Patients with mechanical heart valves receive lifelong oral anticoagulant therapy with vitamin K antagonists (VKAs), such as warfarin, to prevent thromboembolic complications [160,161]. Nevertheless, it has been a challenge to balance the risks of under-anticoagulation against those of excessive anticoagulation [162]. Furthermore, there is a lack of consensus regarding the optimal intensity and timing of anticoagulation to prevent early thromboembolism after mechanical valve replacement [163].
What is a DVT?
Patients with one or more of Virchow's triad of stasis, hypercoagulability, or vein wall abnormalities are susceptible to thrombosis.1 Lower limb deep venous thrombosis (DVT) is a common and potentially serious problem. Over five million occur in the United States annually, and approximately 10% become pulmonary emboli. 2,3 Ninety percent of pulmonary emboli originate from lower limb DVTs. 4,5 DVT can also result in permanent venous obstruction (i.e., chronic DVT) and/or damage to venous valves leading to post-phlebitic chronic venous insufficiency. Timely and accurate diagnosis can aid significantly in the reduction of morbidity and mortality.
What causes EHIT?
Endothelial injury, stasis, and hypercoagulability all may play a role, either individually or in concert, resulting in the development of an EHIT. With regards to endothelial injury, endothermal ablation in fact relies on inducing endothelial injury to effect ablation of the refluxing truncal vein.
How long does a VKA valve last?
For aortic bioprosthetic valves, however, VKA is recommended for 3–6 months according to the AHA/ACC guideline, while aspirin is preferred over VKA in the ESC guidelines. Evidently, the guidelines are not concordant in their recommendations because they are based on different observational retrospective data [168–171].
What is the Virchow's triad?
Virchow’s Triad gives us three main factors that can lead to blood clot formation within a vein. Remember there are THREE factors (hence why it’s called a Triad). Anyone can develop a deep vein thrombosis, especially if these risk factors are present. Remember: “ SHE ”. S tasis of Venous Circulation:
Why is it important to know about Virchow's trichot?
It’s important to be familiar with Virchow’s Triad because it details the main factors for why a blood clot can develop. As the nurse you want to be able to identify those factors and take measures to prevent a blood clot in your patient.
How does blood flow back to the heart?
Therefore, the blood has to flow back to the heart via the veins, and it does this with the assistance of healthy vein valves and the muscles within the extremity. If the vein’s valves are damaged or the muscles aren’t working (or being used) blood isn’t going to flow back very well and a blood clot can develop.
What is heparin induced thrombocytopenia?
Heparin Induced Thrombocytopenia (HIT) Postpartum Period. E ndothelial damage to the vein: This endothelial is a layer of cells that lines the inside of the vein. Damage to this layer can be from a direct or indirect cause, but regardless it stimulates platelets and the coagulation process.
Can blood be static?
Blood cannot just hang out and become static within a vessel. If it does this the blood will start to clump up (due to the present of platelets) and form a clot. The venous system is responsible for taking deoxygenated blood BACK to the heart.