Unsuspected triggers of venous thromboembolism--trivial or not so trivial?

Venous thromboembolism (VTE) can be considered a multifactorial disorder involving a variety of inherited and acquired prothrombotic conditions and events. Although greater emphasis has classically been given to traditional thrombophilic risk factors, there is increasing recognition of less typical precipitating conditions and events. Indeed, the list of plausible but unusual triggers of thrombosis includes sneezing and coughing attacks, eating, migraine, sexual intercourse, strenuous physical exercise, drug abuse, and defecation. Although it is difficult to assert conclusively the true contribution of such events to the etiology of acute episodes of venous thrombosis, it seems reasonable to conclude that the concomitant presence of such trivial elements with one or more additional risk factors for VTE might precipitate an acute thrombotic episode.