Semin Thromb Hemost 2002; 28(s2): 003-014
DOI: 10.1055/s-2002-32312
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Venous Thromboembolism Epidemiology: Implications for Prevention and Management

John A. Heit
  • Division of Cardiovascular Diseases and Section of Hematology Research, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Further Information

Publication History

Publication Date:
19 June 2002 (online)

ABSTRACT

Venous thromboembolism is a major health problem, with an incidence that exceeds 1 per 1000. Over 200,000 new cases occur in the United States annually. Of these, 30% of patients die within 30 days; one-fifth suffer sudden death due to pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has not changed significantly since 1980. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central venous catheter/ transvenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, the risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving patients develop recurrent venous thromboembolism within 10 years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of patients develop venous stasis syndrome within 20 years. To reduce venous thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.

REFERENCES

  • 1 Kurland L T, Molgaard C A. The patient record in epidemiology.  Sci Am . 1981;  245 54-63
  • 2 Melton III J L. History of the Rochester Epidemiology Project.  Mayo Clin Proc . 1996;  71 266-274
  • 3 Silverstein M D, Heit J A, Mohr D N. Trends in the incidence of deep vein thrombosis and pulmonary embolism. A 25-year population-based study.  Arch Intern Med . 1998;  158 585-593
  • 4 Broderick J P. Stroke trends in Rochester, Minnesota, during 1945 to 1984.  Ann Epidemiol . 1993;  3 476-479
  • 5 Anderson Jr A F, Wheeler H B, Goldberg R J. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study.  Arch Intern Med . 1991;  151 933-938
  • 6 Madhok R, Lewallen D G, Wallrichs S L. Trends in the utilization of primary total hip arthroplasty, 1969 through 1990; a population-based study in Olmsted County, Minnesota.  Mayo Clin Proc . 1993;  68 11-18
  • 7 Anderson Jr A F, Wheeler H B, Goldberg R J. Physician practices in the prevention of venous thromboembolism.  Ann Intern Med . 1991;  115 591-595
  • 8 Bratzler D W, Raskob G E, Murray C K, Bumpus L J, Piatt D S. Underuse of venous thromboembolism prophylaxis for general surgery patients. Physician practices in the community hospital setting.  Arch Intern Med . 1998;  158 1909-1912
  • 9 Geerts W H, Heit J A, Clagett G P. Prevention of venous thromboembolism.  Chest . 2001;  119(suppl) 132S-175S
  • 10 Anderson Jr A F, Wheeler H B, Goldberg R J. Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism.  Arch Intern Med . 1994;  154 669-677
  • 11 Heit J A, Silverstein M D, Mohr D N. Predictors of survival after deep vein thrombosis and pulmonary embolism. A population-based, cohort study.  Arch Intern Med . 1999;  159 445-453
  • 12 Alpert J S, Smith R, Carlson J. Mortality in patients treated for pulmonary embolism.  JAMA . 1976;  236 1477-1480
  • 13 Carson J L, Kelley M A, Duff A. The clinical course of pulmonary embolism.  N Engl J Med . 1992;  326 1240-1245
  • 14 Kniffin Jr D W, Baron J A, Barrett J, Birkmeyer J D, Anderson Jr A F. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.  Arch Intern Med . 1994;  154 861-866
  • 15 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED).  JAMA . 1990;  263 2753-2759
  • 16 van Beek J R E, Kuijer P MM, Büller H R. The clinical course of patients with suspected pulmonary embolism.  Arch Intern Med . 1997;  157 2593-2598
  • 17 Konstantinides S, Geibel A, Olschewski M. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry.  Circulation . 1997;  96 882-888
  • 18 Grifoni S, Olivotto I, Cecchini P. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction.  Circulation . 2000;  101 2817-2822
  • 19 Kasper W, Konstantinides S, Geibel A. Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pulmonary embolism.  Heart . 1997;  77 346-349
  • 20 Heit J A, Silverstein M D, Mohr D N. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study.  Arch Intern Med . 2000;  160 809-815
  • 21 Coon W W, Willis III W P, Keller J B. Venous thromboembolism and other venous disease in the Tecumseh community health study.  Circulation . 1973;  48 839-846
  • 22 Kierkegaard A. Incidence of acute deep vein thrombosis in two districts. A phlebographic study.  Acta Chir Scand . 1980;  146 267-269
  • 23 Cogo A, Bernardi E, Prandoni P. Acquired risk factors for deep-vein thrombosis in symptomatic outpatients.  Arch Intern Med . 1994;  154 164-168
  • 24 Coon W W. Risk factors in pulmonary embolism.  Surg Gynecol Obstet . 1976;  143 385-390
  • 25 Quinn D A, Thompson B T, Terrin M L. A prospective investigation of pulmonary embolism in women and men.  JAMA . 1992;  268 1689-1696
  • 26 Goldhaber S Z, Savage D D, Garrison R J. Risk factors for pulmonary embolism. The Framingham study.  Am J Med . 1983;  74 1023-1028
  • 27 Samama M M. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study.  Arch Intern Med . 2000;  160 3415-3420
  • 28 White R H, Gettner S, Newman J M, Trauner K B, Romano P S. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty.  N Engl J Med . 2000;  343 1758-1764
  • 29 Sharrock N E, Haas S B, Hargett M J. Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty.  J Bone Joint Surg Am . 1991;  73 502-506
  • 30 Havig O. Pulmonary thromboembolism (clinicopathological correlations and multiple regression analysis of possible risk factors).  Acta Chir Scand Suppl . 1977;  478 48-80
  • 31 Sandler D A, Martin J F. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?.  J R Soc Med . 1989;  82 203-205
  • 32 Lederle F A. Heparin prophylaxis for medical patients?.  <~>[editorial]. Ann Intern Med . 1998;  128 768-770
  • 33 Rosendaal F R. Risk factors for venous thrombotic disease.  Thromb Haemost . 1999;  82 610-619
  • 34 Coon W W, Coller F A. Some epidemiologic considerations of thromboembolism.  Surg Gynecol Obstet . 1959;  109 487-501
  • 35 Gibbs N M. Venous thrombosis of the lower limbs with particular reference to bed-rest.  Br J Surg . 1957;  XLV 15-236
  • 36 Gross J S, Neufeld R R, Libow L S, Gerber I, Rodstein M. Autopsy study of the elderly institutionalized patient: review of 234 autopsies.  Arch Intern Med . 1988;  148 173-176
  • 37 Ferrari E, Chevallier T, Chapelier A, Baudouy M. Travel as a risk factor for venous thromboembolic disease: a case-control study.  Chest . 1999;  115 440-444
  • 38 Geerts W H, Code K I, Jay R M, Chen E, Szalai J P. A prospective study of venous thromboembolism after major trauma.  N Engl J Med . 1994;  331 1601-1606
  • 39 Goodnough L T, Saito H, Manni A, Jones P K, Pearson O H. Increased incidence of thromboembolism in stage IV breast cancer patients treated with a five-drug chemotherapy regimen. A study of 159 patients.  Cancer . 1984;  54 1264-1268
  • 40 Levine M N, Gent M, Hirsh J. The thrombogenic effect of anticancer drug therapy in women with stage II breast cancer.  N Engl J Med . 1988;  318 404-407
  • 41 Myllynen P, Kammonen M, Rokkanen P. Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with nonparalyzed patients immobilized due to spinal fractures.  J Trauma . 1985;  25 541-543
  • 42 Warlow C, Ogston D, Douglas A S. Deep venous thrombosis of the legs after strokes. Part I-incidence and predisposing factors.  Br Med J . 1976;  1 1178-1181
  • 43 Bromfield E B, Reding M J. Relative risk of deep venous thrombosis or pulmonary embolism post-stroke based on ambulatory status.  J Neuro Rehab . 1988;  2 51-57
  • 44 Danilenko-Dixon D R, Heit J A, Silverstein M D. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum: a population-based, case-control study.  Am J Obstet Gynecol . 2001;  184 104-110
  • 45 Cogo A, Lensing A W, Prandoni P. Comparison of real-time B-mode ultrasonography and Doppler ultrasound with contrast venography in the diagnosis of venous thrombosis in symptomatic outpatients.  Thromb Haemost . 1993;  70 404-407
  • 46 Goldhaber S Z, Grodstein F, Stampfer M J. A prospective study of risk factors for pulmonary embolism in women.  JAMA . 1997;  277 642-645
  • 47 Kierkegaard A. Incidence and diagnosis of deep vein thrombosis associated with pregnancy.  Acta Obstet Gynecol Scand . 1983;  62 239-243
  • 48 Chasan-Taber L, Stampfer M J. Epidemiology of oral contraceptives and cardiovascular disease.  Ann Intern Med . 1998;  128 467-477
  • 49 Jick H, Kaye J A, Vasilakis-Scaramozza C, Jick S S. Risk of venous thromboembolism among users of third generation oral contraceptives compared with users of oral contraceptives with levonorgestrel before and after 1995; cohort and case-control analysis.  BMJ . 2000;  321 1190-1195
  • 50 Devor M, Barrett-Connor E, Renvall M, Feigal Jr D, Ramsdell J. Estrogen replacement therapy and the risk of venous thrombosis.  Am J Med . 1992;  92 275-282
  • 51 Heit J A, Mohr D N, Silverstein M D. Predictors of recurrence after deep vein thrombosis and pulmonary embolism. A population-based cohort study.  Arch Intern Med . 2000;  160 761-768
  • 52 Kearon C, Gent M, Hirsh J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.  N Engl J Med . 1999;  340 901-907
  • 53 Schulman S, Rhedin A-S, Lindmarker P. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism.  N Engl J Med . 1995;  332 1661-1665
  • 54 Schulman S, Svenungsson E, Granqvist S, and the Duration of Anticoagulation Study Group. Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy.  Am J Med . 1998;  104 332-338
  • 55 De Stefano V, Martinelli I, Mannucci P M. The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation.  N Engl J Med . 1999;  341 801-806
  • 56 Mohr D N, Silverstein M D, Heit J A. The venous stasis syndrome after deep venous thrombosis or pulmonary embolism: a population-based study.  Mayo Clin Proc . 2000;  75 1249-1256
  • 57 Heit J A, Rooke T W, Silverstein M D. Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study.  J Vasc Surg . 2001;  33 1022-1027
  • 58 Bergqvist D, Jendteg S, Johansen L, Persson U, Ödegaard K. Cost of long-term complications of deep venous thrombosis of the lower extremities: an analysis of a defined patient population in Sweden.  Ann Intern Med . 1997;  126 454-457
  • 59 Brandjes D PM, Büller H R, Heijboer H. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis.  Lancet . 1997;  349 759-762