Venous thromboembolism: A Call for risk assessment in all hospitalised patients

Thrombosis is a major contributor to the global burden of disease because it is the pathology underlying venous thromboembolism (VTE), ischaemic heart disease, and ischaemic stroke ([1]). Collectively, these disorders account for about 1 in 4 deaths worldwide ([1]). Prevention and treatment of thrombosis are critical for reducing global death and disability.

In 2014, the International Society on Thrombosis and Haemostasis (ISTH) declared October 13 as World Thrombosis Day to increase global awareness about thrombosis, including its risk factors and strategies for prevention, diagnosis, and treatment. VTE was selected as the initial focus of World Thrombosis Day because well-established public awareness campaigns were already focusing on heart disease and stroke through World Heart and World Stroke Days. More specifically, hospital-associated VTE was chosen as the focus for increased awareness and action.

This decision was supported by several pieces of evidence. First, there are compelling data from Europe and the United States documenting the burden of VTE, which includes deep-vein thrombosis (DVT) and pulmonary embolism (PE). Cohen et al. estimated that in 2004 there were more than 600,000 DVT events, 400,000 PE events, and 500,000 VTE-related deaths, across the European Union ([2]). In the United States, investigators from the Centers for Disease Control and Prevention estimated that there were more than 500,000 adult hospitalisations with a diagnosis of VTE each year from 2007 to 2009 ([3]). VTE is responsible for more deaths each year than breast cancer, HIV disease, and motor vehicle crashes combined ([2]).

Second, the available epidemiologic data indicate that approximately 60 % of cases of VTE are associated with a recent hospital stay ([4]). The World Health Organisation (WHO) patient safety program found that hospital-associated VTE was a leading cause of death and disability associated with hospitalisation in low, middle, and high income countries and accounted for more deaths and greater disability than nosocomial pneumonia, catheter-related bloodstream infections, and adverse drug events ([5]).

Public awareness about VTE is low, and lags behind that of other common disorders ([6]). In a global survey, only 44 % and 54 % of respondents were aware of DVT and PE, respectively, and only 45 % of respondents were aware that most cases of VTE were preventable ([6]). Even fewer identified hospitalisation as a risk factor ([6]). An important educational goal of World Thrombosis Day is to arm patients and their families with information to be their own advocates for VTE prevention in high risk settings, such as hospitalisation.

^* See Appendix for Steering Committee members.

• References

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