Thrombotic Risk

Based upon criteria below, choose thrombotic risk

Risk of thrombosis while off anticoagulant can be estimated by indication for anticoagulant. Use the scheme below to identify thrombotic risk as low-to-moderate or as high. Indications are categorized as VT E, mechanical heart valve, a- fib, and thrombophilia.

VENOUS THROMBOEMBOLISM (DVT's & PEIs)
Low:
- VTE > 12 mos ago
Moderate:
- VTE 3-12 mos ago
- Recurrent VTE
High:
- Recent VTE (< 1 month or < 3 mos ago)

HEART VALVES

Low:
- Bileaflet mechanical aortic valve replacement without major risk factors for stroke*
Moderate:
- Bileaflet mechanical aortic valve replacement with major risk factors for stroke*
- Mitral valve replacement without major risk factors for stroke*
High
- Mechanical mitral valve
- Caged ball or tilting-disk valve
- Mechanical heart valve in any position with recent stroke or TIA (<3 mos ago)

* major risk factors for stroke: a-fib, multiple prior strokes/ TIA's not recent (23 mos ago), prior perioperative stroke, or prior valve thrombosis.

THROMBOPHILIA
Low: [none]

Moderate:
- Nonsevere coagulopathy (heterozyg factor V Leiden or prothrombin gene G20210A mutation)
- Active cancer

High
- Recent cardioembolic stroke (<3 mos ago)
- Active cancer associated with high VTE risk
- LV thrombus (within past 3 mos)
- Severe thrombophilia**
- Antiphospholipid antibodies

** severe thrombophilias: protein C defc, protein S defc, or antithrombin defc; homozyg factor V Leiden or prothrombin gene G20210A mutation or double heterozygous for each mutation, multiple thrombophilias

ATRIAL FIBRILLATION
Low:
- CHA2DS2-VASc score 1-4 (without prior history of stroke)
Moderate:
- CHA2DS2-VASc 5-6

High
- CHA2DS2-VASc 7 (or 5-6 with recent stroke or TIA)
- a-fib with rheumatic valvular heart disease