Epidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer

Summary

Contemporary data from population studies on the incidence and complications of venous thromboembolism (VTE) are limited. An observational cohort study was undertaken to estimate the incidence of first and recurrent VTE. The cohort was identified from all patients in the UK Clinical Practice Research Datalink (CPRD) with additional linked information on hospitalisation and cause of death. Between 2001 and 2011, patients with first VTE were identified and the subset without active cancer-related VTE observed for up to 10 years for recurrent VTE. The 10-year cumulative incidence rates (CIR) were derived with adjustment for mortality as a competing risk event. A total of 35,373 first VTE events (12,073 provoked, 16,708 unprovoked and 6592 active cancer-associated VTE) among 26.9 million person-years of observation were identified. The overall incidence rate (IR) of VTE was 131.5 (95% CI, 130.2–132.9) per 100,000 person-years and 107.0 (95% CI, 105.8–108.2) after excluding cancer-associated VTE. DVT was more common in the young and PE was more common in the elderly. VTE recurrence occurred in 3671 (CIR 25.2%). The IR for recurrence peaked in the first six months at around 11 per 100 person years. It levelled out after three years and then remained at around 2 per 100 person years from year 4–10 of follow-up. The IRs for recurrences were particularly high in young men. In conclusion, VTE is common and associated with high recurrence rates. Effort is required to prevent VTE and to reduce recurrences.

Keywords

Thrombosis - pulmonary embolism - deep-vein thrombosis

• References

• 1 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl. 06) 381S-453S.
• 2 Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. Br Med J 1991; 302: 709-711.
• 3 Naess IA, Christiansen SC, Romundstad P. et al. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 05: 692-699.
• 4 Heit JA, Silverstein MD, Mohr DN. et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001; 86: 452-463.
• 5 Spencer FA, Emery C, Joffe SW. et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombol 2009; 28: 401-409.
• 6 Cohen AT, Agnelli G, Anderson FA. et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-764.
• 7 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e419S-494S.
• 8 http://www.cprd.com/ObservationalData/CodedData.asp#SecondaryCare Clinical Practice Research Datalink and link to secondary care
• 9 http://www.cprd.com/dataAccess/Default.asp#CentralMortalityData Clinical Practice Research Datalink and link to Office for National Statistics
• 10 Lawrenson R, Todd JC, Leydon GM. et al. Validation of the diagnosis of venous thromboembolism in general practice database studies. Br J Clin Pharmacol 2000; 49: 591-596.
• 11 Satagopan JM, Ben-Porat L, Berwick M. et al. A note on competing risks in survival data analysis. Br J Cancer 2004; 91: 1229-1235.
• 12 Heit JA, O’Fallon WM, Petterson TM. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248.
• 13 Douketis J, Tosetto A, Marcucci M. et al. Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. Br Med J 2011; 342: d813.
• 14 Kearon C. Long-term anticoagulation for venous thromboembolism: duration of treatment and management of warfarin therapy. Clin Chest Med 2010; 31: 719-730.
• 15 Prandoni P, Lensing AW, Cogo A. et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1-7.
• 16 Huerta C, Johansson S, Wallander MA. et al. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch I ntern Med 2007; 167: 935-943.
• 17 Cohen AT, Edmondson RA, Phillips MJ. et al. The changing pattern of venous thromboembolic disease. Haemostasis 1996; 26: 65-71.
• 18 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-1389.
• 19 Silverstein MD, Heit JA, Mohr DN. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Int Med 1998; 158: 585-593.