The Epidemiology of Venous Thromboembolism in the Community
John A. Heit (1) , Marc D. Silverstein*, David N. Mohr (2) , Tanya M. Petterson (3) , Christine M. Lohse (3) , W. Michael O’Fallon (3) , L. Joseph Melton III (4)
(1) Division of Cardiovascular Diseases and Section of Hematology Research (JAH), and the (2) Division of Area General Internal Medicine (MDS, DNM), Department of Internal Medicine, and the (3) Sections of Biostatistics (WMO, TMP, CML) and (4) Clinical
Summary The incidence of venous thromboembolism exceeds 1 per 1000;over 200,000 new cases occur in the United States annually. Of these,30% die within 30 days; one-fifth suffer sudden death due to pulmonaryembolism. Despite improved prophylaxis, the incidence of venousthromboembolism has been constant since 1980. Independent riskfactors for venous thromboembolism include increasing age, malegender, surgery, trauma, hospital or nursing home confinement, malignancy,neurologic disease with extremity paresis, central venous catheter/transvenous pacemaker, prior superficial vein thrombosis, and varicoseveins; among women, risk factors include pregnancy, oral contraceptives,and hormone replacement therapy. About 30% of surviving casesdevelop recurrent venous thromboembolism within ten years. Independentpredictors for recurrence include increasing age, obesity, malignantneoplasm, and extremity paresis. About 28% of cases developvenous stasis syndrome within 20 years. To reduce venous thromboembolismincidence, improve survival, and prevent recurrence andcomplications, patients with these characteristics should receive appropriateprophylaxis.