Thromb Haemost 2017; 117(12): 2243-2260
DOI: 10.1160/TH17-02-0134
Review Article
Schattauer GmbH Stuttgart

Incidence of Venous Thromboembolism in Asian Populations: A Systematic Review

Lai Heng Lee
,
Alexander Gallus
,
Ravul Jindal
,
Chen Wang
,
Chau-Chung Wu
Further Information

Publication History

24 February 2017

07 September 2017

Publication Date:
06 December 2017 (online)

Abstract

Introduction Despite a marked recent increase in the number of publications describing the incidence of venous thromboembolism (VTE) in Asia, and especially in mainland China, Hong Kong, Taiwan, Korea, Japan and Singapore, there remains a lack of consensus on the true risks, and trends over time, to inform appropriate clinical practice. The purpose of this systematic review was therefore to examine evidence about the incidence of symptomatic VTE in Asia.

Methods Databases were searched for studies from Asia, published between January 1995 and February 2016, on the incidence of symptomatic VTE, deep vein thrombosis (DVT) or pulmonary embolism. Review of eligible studies was conducted independently by two reviewers. Data were extracted on incidence, predispositions and recurrence of VTE.

Results One thousand nighty-five studies were identified, of which 73 were eligible for full text review and data extraction. Three population-wide estimates of VTE rates identified from Korea, Taiwan and Hong Kong reported annual incidences of 13.8, 15.9 and 19.9 per 100,000, respectively. Nine studies of Asian hospital registries or databases reported VTE rates ranging from 11 to 88 cases per 10,000 admissions. Population-based estimates of post-surgical DVT rates ranged from 0.15 to 1.35%. Age was a significant risk factor for VTE in all population groups.

Conclusion Population-wide incidence estimates in Asia were approximately 15 to 20% of the levels recorded in western countries but have increased over time. It is anticipated this synthesis of evidence on the incidence of VTE and its predisposing factors will increase awareness about VTE in Asian populations.

Authors' Contributions

All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication.


Study conception and design: L.H.L., A.G., R.J., C.W., and C.C.W.


Acquisition of data: L.H.L. and A.G.


Analysis and interpretation of data: L.H.L., A.G., R.J., C.W., and C.C.W.


Supplementary Material

 
  • References

  • 1 Roberts LN, Patel RK, Arya R. Venous thromboembolism and ethnicity. Br J Haematol 2009; 146 (04) 369-383
  • 2 Bounameaux H, Rosendaal FR. Venous thromboembolism: why does ethnicity matter?. Circulation 2011; 123 (20) 2189-2191
  • 3 Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis 2006; 21 (01) 23-29
  • 4 Angchaisuksiri P. Venous thromboembolism in Asia: an unrecognised and under-treated problem?. Thromb Haemost 2011; 106 (04) 585-590
  • 5 Guyatt G, Drummond R, Meade M. , et al. The Evidence Based-Medicine Working Group Users' Guides to the Medical Literature. 3rd ed. Chicago, IL: McGraw Hill; 2013
  • 6 Liberati A, Altman DG, Tetzlaff J. , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
  • 7 Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (01) 85-91
  • 8 Lee CH, Lin LJ, Cheng CL, Kao Yang YH, Chen JY, Tsai LM. Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population. J Thromb Haemost 2010; 8 (07) 1515-1523
  • 9 Cheuk BL, Cheung GC, Cheng SW. Epidemiology of venous thromboembolism in a Chinese population. Br J Surg 2004; 91 (04) 424-428
  • 10 Sakuma M, Konno Y, Shirato K. Increasing mortality from pulmonary embolism in Japan, 1951-2000. Circ J 2002; 66 (12) 1144-1149
  • 11 Chung WS, Lin CL, Chang SN, Lu CC, Kao CH. Systemic lupus erythematosus increases the risks of deep vein thrombosis and pulmonary embolism: a nationwide cohort study. J Thromb Haemost 2014; 12 (04) 452-458
  • 12 Chung WS, Lin CL, Sung FC. , et al. Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Rheumatology (Oxford) 2014; 53 (09) 1639-1645
  • 13 Chen WJ, Lin CC, Lin CY. , et al. Pulmonary embolism in chronic obstructive pulmonary disease: a population-based cohort study. COPD 2014; 11 (04) 438-443
  • 14 Chung WS, Lin CL, Ho FM. , et al. Asthma increases pulmonary thromboembolism risk: a nationwide population cohort study. Eur Respir J 2014; 43 (03) 801-807
  • 15 Chen CY, Liao KM. The incidence of deep vein thrombosis in Asian patients with chronic obstructive pulmonary disease. Medicine (Baltimore) 2015; 94 (44) e1741
  • 16 Chung WS, Lin CL, Sung FC, Hsu WH, Chen YF, Kao CH. Increased risks of deep vein thrombosis and pulmonary embolism in Sjögren syndrome: a nationwide cohort study. J Rheumatol 2014; 41 (05) 909-915
  • 17 Chung WS, Peng CL, Lin CL. , et al. Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann Rheum Dis 2014; 73 (10) 1774-1780
  • 18 Kang JH, Keller JJ, Lin YK, Lin HC. A population-based case-control study on the association between rheumatoid arthritis and deep vein thrombosis. J Vasc Surg 2012; 56 (06) 1642-1648
  • 19 Chen YG, Lin TY, Huang WY, Lin CL, Dai MS, Kao CH. Association between pneumococcal pneumonia and venous thromboembolism in hospitalized patients: a nationwide population-based study. Respirology 2015; 20 (05) 799-804
  • 20 Lin TY, Chen YG, Huang WY. , et al. Association between chronic osteomyelitis and deep-vein thrombosis. Analysis of a nationwide population-based registry. Thromb Haemost 2014; 112 (03) 573-579
  • 21 Chung WS, Lin CL, Chen YF, Hsu WH, Kao CH. Pulmonary tuberculosis increases the risk of pulmonary thromboembolism: a nationwide population-based cohort study. Thromb Haemost 2014; 112 (06) 1325-1327
  • 22 Wang CC, Chang CT, Lin CL, Lin IC, Kao CH. Hepatitis C virus infection associated with an increased risk of deep vein thrombosis: a population-based cohort study. Medicine (Baltimore) 2015; 94 (38) e1585
  • 23 Ng KJ, Lee YK, Huang MY, Hsu CY, Su YC. Risks of venous thromboembolism in patients with liver cirrhosis: a nationwide cohort study in Taiwan. J Thromb Haemost 2015; 13 (02) 206-213
  • 24 Chung WS, Lin CL, Chang SN, Chung HA, Sung FC, Kao CH. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res 2014; 133 (04) 579-584
  • 25 Lim YP, Lin CL, Hung DZ, Ma WC, Lin YN, Kao CH. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with organophosphate intoxication: a nationwide prospective cohort study. Medicine (Baltimore) 2015; 94 (01) e341
  • 26 Chung WS, Lin CL, Kao CH. Carbon monoxide poisoning and risk of deep vein thrombosis and pulmonary embolism: a nationwide retrospective cohort study. J Epidemiol Community Health 2015; 69 (06) 557-562
  • 27 Hsu WY, Lane HY, Lin CL, Kao CH. A population-based cohort study on deep vein thrombosis and pulmonary embolism among schizophrenia patients. Schizophr Res 2015; 162 (1–3): 248-252
  • 28 Chung WS, Chen YF, Lin CL, Chang SN, Hsu WH, Kao CH. Sleep disorders increase the risk of venous thromboembolism in individuals without sleep apnea: a nationwide population-based cohort study in Taiwan. Sleep Med 2015; 16 (01) 168-172
  • 29 Lee CH, Cheng CL, Kao Yang YH, Lin LJ. Hormone therapy and risk of venous thromboembolism among postmenopausal women in Taiwan: a 10-year nationwide population-based study. Circ J 2015; 79 (05) 1107-1114
  • 30 Chung WS, Lin CL, Kao CH. Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study. Thromb Haemost 2015; 114 (04) 812-818
  • 31 Lu DY, Huang CC, Huang PH. , et al. Metformin use in patients with type 2 diabetes mellitus is associated with reduced risk of deep vein thrombosis: a non-randomized, pair-matched cohort study. BMC Cardiovasc Disord 2014; 14: 187
  • 32 Wu PK, Chen CF, Chung LH, Liu CL, Chen WM. Population-based epidemiology of postoperative venous thromboembolism in Taiwanese patients receiving hip or knee arthroplasty without pharmacological thromboprophylaxis. Thromb Res 2014; 133 (05) 719-724
  • 33 Lee CH, Cheng CL, Chang CH. , et al. Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low-risk populations: a nationwide study in Taiwan. J Thromb Haemost 2012; 10 (01) 56-63
  • 34 Lee CH, Lin TC, Cheng CL, Yang CY, Lin LJ, Kao Yang YH. Comparative risk of venous thromboembolism between total knee and hip replacement: a 10-year nationwide population-based study in Taiwan. J Thromb Haemost 2013; 11 (10) 1930-1932
  • 35 Masuda K, Chikuda H, Yasunaga H. , et al. Factors affecting the occurrence of pulmonary embolism after spinal surgery: data from the national administrative database in Japan. Spine J 2012; 12 (11) 1029-1034
  • 36 Yhim HY, Jang MJ, Bang SM. , et al. Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2014; 12 (07) 1035-1043
  • 37 Lee SY, Ro H, Chung CY. , et al. Incidence of deep vein thrombosis after major lower limb orthopedic surgery: analysis of a nationwide claim registry. Yonsei Med J 2015; 56 (01) 139-145
  • 38 Lee J, Kim SC, Kim SJ. , et al. Prevention of venous thromboembolism in medical intensive care unit: a multicenter observational study in Korea. J Korean Med Sci 2014; 29 (11) 1572-1576
  • 39 Lee S, Hwang JI, Kim Y, Yoon PW, Ahn J, Yoo JJ. Venous thromboembolism following hip and knee replacement arthroplasty in Korea: a nationwide study based on claims registry. J Korean Med Sci 2016; 31 (01) 80-88
  • 40 Jang MJ, Bang SM, Oh D. Incidence of pregnancy-associated venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (12) 2519-2521
  • 41 Yang Y, Liang L, Zhai Z. , et al; Investigators for National Cooperative Project for Prevention and Treatment of PTE-DVT. Pulmonary embolism incidence and fatality trends in Chinese hospitals from 1997 to 2008: a multicenter registration study. PLoS One 2011; 6 (11) e26861
  • 42 Zhou X, Qian W, Li J. , et al. Who are at risk for thromboembolism after arthroplasty? A systematic review and meta-analysis. Thromb Res 2013; 132 (05) 531-536
  • 43 Lee AD, Stephen E, Agarwal S, Premkumar P. Venous thrombo-embolism in India. Eur J Vasc Endovasc Surg 2009; 37 (04) 482-485
  • 44 Kishimoto M, Lim HY, Tokuda Y. , et al. Prevalence of venous thromboembolism at a teaching hospital in Okinawa, Japan. Thromb Haemost 2005; 93 (05) 876-879
  • 45 Choi WI, Lee MY, Oh D, Rho BH, Hales CA. Estimated incidence of acute pulmonary embolism in a Korean hospital. Clin Appl Thromb Hemost 2011; 17 (03) 297-301
  • 46 Lee LH, Gu KQ, Heng D. Deep vein thrombosis is not rare in Asia--the Singapore General Hospital experience. Ann Acad Med Singapore 2002; 31 (06) 761-764
  • 47 Ng HJ, Lee LH. Trends in prevalence of deep venous thrombosis among hospitalised patients in an Asian institution. Thromb Haemost 2009; 101 (06) 1095-1099
  • 48 Molina JA, Jiang ZG, Heng BH, Ong BK. Venous thromboembolism at the National Healthcare Group, Singapore. Ann Acad Med Singapore 2009; 38 (06) 470-478
  • 49 Yang Y, Zhang XZ, Ng HS, Fong JC, Lee LH. The effect of chronic liver disease on venous thromboembolism among medically managed patients in Singapore General Hospital. Thromb Res 2015; 136 (03) 548-551
  • 50 Kunisawa S, Ikai H, Imanaka Y. Incidence and prevention of postoperative venous thromboembolism: are they meaningful quality indicators in Japanese health care settings?. World J Surg 2012; 36 (02) 280-286
  • 51 Yu YB, Gau JP, Liu CY. , et al. A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system. Thromb Haemost 2012; 108 (02) 225-235
  • 52 Chew TW, Gau CS, Wen YW, Shen LJ, Mullins CD, Hsiao FY. Epidemiology, clinical profile and treatment patterns of venous thromboembolism in cancer patients in Taiwan: a population-based study. BMC Cancer 2015; 15: 298
  • 53 Lee YG, Kim I, Lee E. , et al. Risk factors and prognostic impact of venous thromboembolism in Asian patients with non-small cell lung cancer. Thromb Haemost 2014; 111 (06) 1112-1120
  • 54 Wang Z, Yan HH, Yang JJ. , et al. Venous thromboembolism risk factors in Chinese non-small cell lung cancer patients. Support Care Cancer 2015; 23 (03) 635-641
  • 55 Tsai SJ, Ruan YX, Lee CC. , et al. The incidence of venous thromboembolism in cervical cancer: a nationwide population-based study. BMC Res Notes 2012; 5: 316
  • 56 Oranratanaphan S, Termrungruanglert W, Khemapech N. Incidence and clinical characteristic of venous thromboembolism in gynecologic oncology patients attending King Chulalongkorn Memorial Hospital over a 10 year period. Asian Pac J Cancer Prev 2015; 16 (15) 6705-6709
  • 57 Kang MJ, Ryoo BY, Ryu MH. , et al. Venous thromboembolism (VTE) in patients with advanced gastric cancer: an Asian experience. Eur J Cancer 2012; 48 (04) 492-500
  • 58 Kato A, Takano H, Ichikawa A. , et al. A retrospective cohort study of venous thromboembolism(VTE) in 1035 Japanese myeloma patients treated with thalidomide; lower incidence without statistically significant association between specific risk factors and development of VTE and effects of thromboprophylaxis with aspirin and warfarin. Thromb Res 2013; 131 (02) 140-144
  • 59 Lee YG, Kim I, Kwon JH. , et al. Implications of cytogenetics for venous thromboembolism in acute myeloid leukaemia. Thromb Haemost 2015; 113 (01) 201-208
  • 60 Sugimura K, Sakuma M, Shirato K. Potential risk factors and incidence of pulmonary thromboembolism in Japan: results from an overview of mailed questionnaires and matched case-control study. Circ J 2006; 70 (05) 542-547
  • 61 ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost 2014; 12 (10) 1580-1590
  • 62 Cohen AT, Agnelli G, Anderson FA. , et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04) 756-764
  • 63 Tamariz L, Harkins T, Nair V. A systematic review of validated methods for identifying venous thromboembolism using administrative and claims data. Pharmacoepidemiol Drug Saf 2012; 21 (Suppl. 01) 154-162
  • 64 Xin G, Wei Z, Ji C. , et al. Metformin uniquely prevents thrombosis by inhibiting platelet activation and mtdna release. Sci Rep 2016; 6: 36222
  • 65 Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton III LJ. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000; 160 (06) 761-768
  • 66 Wendelboe AM, McCumber M, Hylek EM, Buller H, Weitz JI, Raskob G. ; ISTH Steering Committee for World Thrombosis Day. Global public awareness of venous thromboembolism. J Thromb Haemost 2015; 13 (08) 1365-1371
  • 67 Chan LY, Tam WH, Lau TK. Venous thromboembolism in pregnant Chinese women. Obstet Gynecol 2001; 98 (03) 471-475
  • 68 Liew NC, Alemany GV, Angchaisuksiri P. , et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol 2017; 36 (01) 1-20
  • 69 Wang KL, Chu PH, Lee CH. , et al. Management of venous thromboembolisms: part I. The consensus for deep vein thrombosis. Acta Cardiol Sin 2016; 32 (01) 1-22
  • 70 Bang SM, Jang MJ, Kim KH. , et al. Prevention of venous thromboembolism, 2nd edition: Korean Society of Thrombosis and Hemostasis Evidence-based Clinical Practice Guidelines. J Korean Med Sci 2014; 29 (02) 164-171
  • 71 Cohen AT. ; Asia-Pacific Thrombosis Advisory Board. Asia-Pacific Thrombosis Advisory Board consensus paper on prevention of venous thromboembolism after major orthopaedic surgery. Thromb Haemost 2010; 104 (05) 919-930
  • 72 JCS Joint Working Group. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J 2011; 75 (05) 1258-1281
  • 73 Parakh R, Kakkar VV, Kakkar AK. ; Venous Thromboembolism (VTE) Core Study Group. Management of venous thromboembolism. J Assoc Physicians India 2007; 55: 49-70
  • 74 Rahman ARA, Sathar J, Chee CC. , et al. Malaysian Clinical Practice Guidelines: Prevention and Treatment of Venous Thromboembolism. Available at: http://www.moh.gov.my/penerbitan/CPG2017/9005.pdf . Accessed May 23, 2017
  • 75 ST LI T, Working Group for the Prevention of Venous Thromboembolism in ICU in Hong Kong, HKSCCM. Prevention of Venous Thromboembolism in Intensive Care Units in Hong Kong. Available at: http://hksccm.org/index.php/professional/133-clinical-management/1756-prevention-of-venous-thromboembolism-in-icu-in-hong-kong . Accessed Oct 25, 2017
  • 76 Chung WS, Lin CL, Hsu WH, Kao CH. Inflammatory bowel disease increases the risks of deep vein thrombosis and pulmonary embolism in the hospitalized patients: a nationwide cohort study. Thromb Res 2015; 135 (03) 492-496
  • 77 Chung WS, Lin CL, Sung FC, Lu CC, Kao CH. Increased risk of venous thromboembolism in patients with dermatomyositis/polymyositis: a nationwide cohort study. Thromb Res 2014; 134 (03) 622-626
  • 78 Wang CC, Lin CL, Wang GJ, Chang CT, Sung FC, Kao CH. Atrial fibrillation associated with increased risk of venous thromboembolism. A population-based cohort study. Thromb Haemost 2015; 113 (01) 185-192
  • 79 Zhou HX, Peng LQ, Yan Y. , et al. Validation of the Caprini risk assessment model in Chinese hospitalized patients with venous thromboembolism. Thromb Res 2012; 130 (05) 735-740
  • 80 Aniwan S, Rojnuckarin P. High incidence of symptomatic venous thromboembolism in Thai hospitalized medical patients without thromboprophylaxis. Blood Coagul Fibrinolysis 2010; 21 (04) 334-338
  • 81 Rojnuckarin P, Uaprasert N, Vajragupta L, Numkarunarunrote N, Tanpowpong N, Sutcharitchan P. Risk factors for symptomatic venous thromboembolism in Thai hospitalised medical patients. Thromb Haemost 2011; 106 (06) 1103-1108
  • 82 Chen CC, Lee TH, Chung CY. , et al. Symptomatic pulmonary embolism among stroke patients in Taiwan: a retrospective cohort study. Top Stroke Rehabil 2012; 19 (05) 361-368
  • 83 Wong TH, Koh MP, Ng J. Symptomatic venous thromboembolism in Asian major trauma patients: incidence, presentation and risk factors. Eur J Trauma Emerg Surg 2013; 39 (05) 495-500
  • 84 Won MH, Lee GW, Lee TJ, Moon KH. Prevalence and risk factors of thromboembolism after joint arthroplasty without chemical thromboprophylaxis in an Asian population. J Arthroplasty 2011; 26 (07) 1106-1111
  • 85 Wu PK, Chen CF, Chung LH, Liu CL, Chen WM. Pulmonary embolism following total knee arthroplasty in Taiwanese patients. J Chin Med Assoc 2014; 77 (03) 155-159
  • 86 Leizorovicz A, Turpie AG, Cohen AT, Wong L, Yoo MC, Dans A. ; SMART Study Group. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost 2005; 3 (01) 28-34
  • 87 Park YG, Ha CW, Lee SS, Shaikh AA, Park YB. Incidence and fate of ‘Symptomatic’ venous thromboembolism after knee arthroplasty without pharmacologic prophylaxis in an Asian population. J Arthroplasty 2016; 31 (05) 1072-1077
  • 88 Tsuda Y, Yasunaga H, Horiguchi H, Fushimi K, Kawano H, Tanaka S. Effects of fondaparinux on pulmonary embolism following hemiarthroplasty for femoral neck fracture: a retrospective observational study using the Japanese Diagnosis Procedure Combination database. J Orthop Sci 2014; 19 (06) 991-996
  • 89 Chan LY, Yuen PM, Lo WK, Lau TK. Symptomatic venous thromboembolism in Chinese patients after gynecologic surgery: incidence and disease pattern. Acta Obstet Gynecol Scand 2002; 81 (04) 343-346
  • 90 Qu H, Li Z, Zhai Z. , et al. Predicting of venous thromboembolism for patients undergoing gynecological surgery. Medicine (Baltimore) 2015; 94 (39) e1653
  • 91 Yang SS, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC. Symptomatic venous thromboembolism in Asian colorectal cancer surgery patients. World J Surg 2011; 35 (04) 881-887
  • 92 Liu HS, Kho BC, Chan JC. , et al. Venous thromboembolism in the Chinese population–experience in a regional hospital in Hong Kong. Hong Kong Med J 2002; 8 (06) 400-405
  • 93 Cheng G, Chan C, Liu YT. , et al. Incidence of deep vein thrombosis in hospitalized Chinese medical patients and the impact of DVT prophylaxis. Thrombosis 2011; 2011: 629383
  • 94 Nakamura M, Sakuma M, Yamada N. , et al; JaSPER investigators. Risk factors of acute pulmonary thromboembolism in Japanese patients hospitalized for medical illness: results of a multicenter registry in the Japanese society of pulmonary embolism research. J Thromb Thrombolysis 2006; 21 (02) 131-135