Table 3.
Factors That Increase the Risk of Thrombosis
| Underlying Thrombotic Disorder or Risk Factor | Thrombosis Risk Level | |
|---|---|---|
| Very-high Riska | High Riskb | |
| ASCVD | Previous ACS Stable angina, Coronary revascularization (PCI, CABG, and other), Stroke and TIA PAD Documented plaques on coronary angiography or CT scan, or on carotid ultrasound; DM with target organ damage, or at least 3 major risk factors, Early onset of T1DM of long duration (> 20 y); Severe CKD (eGFR < 30 ml/min/1.73 m2) |
|
| Left ventricular thrombus | Estimated MACE 37.1%; mortality 18.9%; stroke 13.3%; over 2 y | |
| Mechanical heart valves | Risk of ischemic stroke >10%/y: mitral position, recently placed prosthesis (<3 mo), prosthesis and additional CV risk factor, specific types of valve (Starr Edwards, Bjork Shiley); aortic position with additional risk factors (AF, LVEF <35%, history of thromboembolism) | |
| Mitral biological valve | Systemic TE >5%/y at <3 mo after implantation | |
| Aortic biological valve | Systemic TE >5%/y at <3 mo after implantation plus recent history of TE or presence of left atrial thrombi | |
| Rheumatic mitral valve disease | - plus AF - plus left atrial diameter >55 mm or left atrial thrombus or prior TE |
|
| AF | Plus recent (<30 d) cardioembolic stroke 10.1% of recurrent ischemic stroke, TIA, and systemic arterial embolism |
CHA2DS2-VASc score ≥4 Risk of ischemic stroke ≥4.8%/y Risk of ischemic stroke/TIA/systemic embolism ≥6.7%/y |
| AF + ASCVD | AF plus recent PCI <30 d | AF and PCI/ACS in the previous 12 mo |
| PFO/LAA closure | Thrombus formation on the device: ~1% of patients undergoing ASD/PFO closure and 2–5% of patients undergoing LAA closure | |
| PE/DVT | PE with hemodynamic instability | - Acute DVT - PE since diagnosis <6 wks |
| Type of cancer | - >4%/y: brain tumors, multiple myeloma, pancreas, stomach cancer (as advanced/metastatic disease) - Khorana score ≥2 |
|
| Chemotherapy/anticancer therapy | - Venous TE: • Cisplatin-based chemotherapy • Cytostatic: capecitabine, gemcitabine, paclitaxel • Tamoxifen • Immunomodulatory drugs: thalidomide, lenalidomide - Arterial TE: • Aromatase inhibitors • Androgen-deprivation therapy • VEGF-targeted drugs (eg, bevacizumab, ramucirumab, sunitinib, sorafenib, pazopanib, axitinib, cabozantinib, regorafenib, lenvatinib, vandetanib, aflibercept) • BCR-ABL TKI (nilotinib, ponatinib) |
|
| Cancer-associated conditions or comorbidities | - Cancer-related surgery - Allogeneic transplantation (subgroup with prior VTE) - APS |
|
aRisk of fatal cardiovascular disease ≥1%/y.
bRisk of fatal cardiovascular disease: 0.5–<1%/y.
ACS = acute coronary syndrome; AF = atrial fibrillation; APS = antiphospholipid syndrome; ASCVD = Atherosclerotic cardiovascular disease; CABG = coronary artery bypass graft; CAD = coronary artery disease; CKD = chronic kidney disease; CT = computed tomography; CV = cardiovascular; DAPT = dual antiplatelet therapy; DM = diabetes mellitus; DVT = deep vein thrombosis; LAA = left atrial appendage; LVEF = left ventricular ejection fraction; MACE = major adverse cardiac events; PAD = peripheral artery disease; PCI = postpercutaneous coronary intervention; PE = pulmonary embolism; PFO = patent foramen ovale; TIA = transient ischemic attack; T1DM = diabetes mellitus type 1; TE = thromboembolism; VEGF = vascular endothelial growth factor; VTE = venous thromboembolism.