Hypercoagulable states associated with chronic venous insufficiency
This chapter discusses the hypercoagulable states associated with chronoic venous insufficiency. For many patients with deep venous thrombosis (DVT), the clinical course following an initial thrombotic event may be complicated by further manifestations of venous disease formerly referred to as the post-thrombotic syndrome. In patients who progress to chronic venous insufficiency (CVI), the currently accepted terminology, approximately 4% will progress to develop venous ulceration. Chronic venous insufficiency is a direct result of sustained venous hypertension. The persistence of venous hypertension leads to the most severe form of chronic venous insufficiency: chronic venous ulceration. A combination of factors including high thrombotic recurrence rates, ineffective anticoagulant treatment, and a poorly understood disease process makes venous ulceration difficult to both prevent and manage. Subsequent chronic venous ulceration includes persistent untreated primary venous insufficiency and repetitive post-thrombotic episodes of recurrent DVT. Thrombophilia conditions can be identified in one-quarter to one-third of patients with a deep venous thrombosis. Inherited thrombophilias are characterized by a genetic predisposition to venous thrombotic events. They are frequently the cause of vascular thrombosis in younger individuals and may contribute to deep venous thrombosis at any age. A variety of acquired thrombophilia conditions exist that may lead to the venous thrombotic disease.
