Epidemiology and Risk Factors of Venous Thromboembolism

ABSTRACT

Venous thromboembolism (VTE) is a common disorder that can affect apparently healthy as well as hospitalized patients. The actual incidence and prevalence of this disease are difficult to estimate because of its often silent nature. The clinical relevance of VTE is highlighted by the important rates of recurrence and mortality. The individual risk of VTE varies as a result of a complex interaction between congenital and transient or permanent acquired risk factors. Risk factors can be either intrinsic (e.g., age, obesity, history of VTE, or thrombophilia) or disease related (e.g., surgical procedures and medical disorders such as cancer, heart failure, or acute respiratory failure). The presence or absence of specific risk factors may play an important role in decisions about the type (and duration) of thromboprophylaxis/anticoagulation to be used.

KEYWORDS

Venous thromboembolism - epidemiology - risk factors - prophylaxis

REFERENCES

• 1 Turkstra F, Kuijer P MM, van Beek E JR et al.. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism.  Ann Intern Med. 1997;  126 775-781
• 2 Meignan M, Rosso J, Gauthier H et al.. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis.  Arch Intern Med. 2000;  160 159-164
• 3 Kyrle P A, Eichinger S. Deep vein thrombosis.  Lancet. 2005;  365 1163-1174
• 4 White R H. The epidemiology of venous thromboembolism.  Circulation. 2003;  107(23 Suppl 1) I4-8
• 5 Anderson Jr F A, Wheeler H B, Goldberg R J et al.. 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 Silverstein M D, Heit J A, Mohr D N, Petterson T M, O'Fallon W M, Melton III J. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.  Arch Intern Med. 1998;  158 585-593
• 7 Nordstrom M, Lindblad B, Bergqvist D, Kjellstrom T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population.  J Intern Med. 1992;  232 155-160
• 8 Oger E. Incidence of venous thromboembolism: a community-based study in western France.  Thromb Haemost. 2000;  83 657-660
• 9 Kyrle P A, Minar E, Bialonczyk C, Hirschl M, Weltermann A, Eichinger S. The risk of recurrent venous thromboembolism in men and women.  N Engl J Med. 2004;  350 2558-2563
• 10 Christiansen S C, Cannegieter S C, Koster T, Vandenbroucke J P, Rosendaal F R. Thrombophilia, clinical factors, and recurrent venous thrombotic events.  JAMA. 2005;  293 2352-2361
• 11 White R H, Zhou H, Romano P S. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California.  Ann Intern Med. 1998;  128 737-740
• 12 Ridker P M, Miletich J P, Hennekens C H et al.. Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening.  JAMA. 1997;  277 1305-1307
• 13 Herrmann F H, Koesling M, Schroder W et al.. Prevalence of factor V Leiden mutation in various populations.  Genet Epidemiol. 1997;  14 403-411
• 14 Bounameaux H, Hicklin L, Desmarais S. Seasonal variation in deep vein thrombosis.  BMJ. 1996;  312 284-285
• 15 Wroblewski B M, Siney P, White R. Seasonal variation in fatal pulmonary embolism after hip arthroplasty.  Lancet. 1990;  335 56
• 16 Prandoni P, Lensing A WA, Cogo A et al.. The long-term clinical course of acute deep venous thrombosis.  Ann Intern Med. 1996;  125 1-7
• 17 Heit J A, Mohr D N, Silverstein M D, Petterson T M, O'Fallon W M, Melton III L J. Predictors of recurrence after deep vein thrombosis and pulmonary embolism.  Arch Intern Med. 2000;  160 761-768
• 18 Heit J A, Silverstein M D, Mohr D N, Petterson T M, O'Fallon W M, Melton III L J. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study.  Arch Intern Med. 1999;  159 445-453
• 19 Goldhaber S Z, Visani L, De Rosa M. for ICOPER. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER).  Lancet. 1999;  353 1386-1389
• 20 Virchow R. Gesammelte Abhandlungen zur wissenschaftlichen Medizin. Frankfurt, Germany; Medinger Sohn 1856: 219-732
• 21 Rosendaal F R. Venous thrombosis: a multicausal disease.  Lancet. 1999;  353 1167-1173
• 22 Hansson P O, Welin L, Tibblin G, Eriksson H. Deep vein thrombosis and pulmonary embolism in the general population. The Study of Men Born in 1913.  Arch Intern Med. 1997;  157 1665-1670
• 23 Goldhaber S Z, Grodstein F, Stampfer M J et al.. A prospective study of risk factors for pulmonary embolism in women.  JAMA. 1997;  277 642-645
• 24 Tsai A W, Cushman M, Rosamond W D, Heckbert S R, Polak J F, Folsom A R. Cardiovascular risk factors and venous thromboembolism incidence.  Arch Intern Med. 2002;  162 1182-1189
• 25 Abdollahi M, Cushman M, Rosendaal F R. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use.  Thromb Haemost. 2003;  89 493-498
• 26 Hansson P O, Eriksson H, Welin L, Svardsudd K, Wilhelmsen L. Smoking and abdominal obesity. Risk factors for venous thromboembolism among middle-aged men: The Study of Men Born in 1913.  Arch Intern Med. 1999;  159 1886-1890
• 27 Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism-results of the Spanish Multicentric Study on Thrombophilia.  Thromb Haemost. 1997;  77 444-451
• 28 Wells P S, Blajchman M A, Henderson P et al.. Prevalence of antithrombin deficiency in healthy blood donors: a cross sectional study.  Am J Hematol. 1994;  45 321-324
• 29 Tait R C, Walker I D, Perry D J et al.. Prevalence of antithrombin deficiency in the healthy population.  Br J Haematol. 1994;  87 106-112
• 30 Martinelli I, Mannucci P M, De Stefano V et al.. Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families.  Blood. 1998;  92 2353-2358
• 31 Tait R C, Walker I D, Reitsma P H et al.. Prevalence of protein C deficiency in the healthy population.  Thromb Haemost. 1995;  73 87-93
• 32 Ben-Tal O, Zivelin A, Selighson U. The relative frequency of hereditary thrombotic disorders among 107 patients with thrombophilia in Israel.  Thromb Haemost. 1989;  61 50-54
• 33 Crowther M A, Kelton J G. Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system.  Ann Intern Med. 2003;  138 128-134
• 34 Koster T, Rosendaal F R, de Ronde H, Briet E, Vandenbroucke J P, Bertina R M. Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden Thrombophilia Study.  Lancet. 1993;  342 1503-1506
• 35 Salomon O, Steinberg D M, Zivelin A et al.. Single and combined prothrombotic factors in patients with idiopathic venous thromboembolism: prevalence and risk assessment.  Arterioscler Thromb Vasc Biol. 1999;  19 511-518
• 36 Ridker P M, Goldhaber S Z, Danielson E et al. for the PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism.  N Engl J Med. 2003;  348 1425-1433
• 37 Poort S R, Rosendaal F R, Reitsma P H, Bertina R M. A common genetic variation in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis.  Blood. 1996;  88 3698-3703
• 38 Rosendaal F R, Doggen C J, Zivelin A et al.. Geographic distribution of the 20210 G to A prothrombin variant.  Thromb Haemost. 1998;  79 706-708
• 39 Goyette P, Frosst P, Rosenblatt D S, Rozen R. Seven novel mutations in the methylenetetrahydrofolate reductase gene and genotype/phenotype correlations in severe methylenetetrahydrofolate reductase deficiency.  Am J Hum Genet. 1995;  56 1052-1059
• 40 Mudd S H, Skovby F, Levy H L et al.. The natural history of homocystinuria due to cystathionine beta-synthase deficiency.  Am J Hum Genet. 1985;  37 1-31
• 41 Kluijtmans L A, van den Heuvel L P, Boers G H et al.. Molecular genetic analysis in mild hyperhomocysteinemia: a common mutation in the methylenetetrahydrofolate reductase gene is a genetic risk factor for cardiovascular disease.  Am J Hum Genet. 1996;  58 35-41
• 42 Levine J S, Branch D W, Rauch J. The antiphospholipid syndrome.  N Engl J Med. 2002;  346 752-763
• 43 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
• 44 Schulman S, Granqvist S, Holmström M et al.. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism.  N Engl J Med. 1997;  336 393-398
• 45 Schulman S, Lockner D, Juhlin-Dannfelt A. The duration of oral anticoagulation after deep vein thrombosis. A randomized study.  Acta Med Scand. 1985;  217 547-552
• 46 Geerts W H, Pineo G P, Heit J A et al.. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126(suppl 3) 338S-400S
• 47 Dahl O E, Gudmundsen T E, Haukeland L. Late occurring clinical deep vein thrombosis in joint-operated patients.  Acta Orthop Scand. 2000;  71 47-50
• 48 Demers C, Marcoux S, Ginsberg J S et al.. Incidence of venographically proved deep vein thrombosis after knee arthroscopy.  Arch Intern Med. 1998;  158 47-50
• 49 Delis K T, Hunt N, Strachan R K et al.. Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy.  Thromb Haemost. 2001;  86 817-821
• 50 Stringer M D, Steadman C A, Hedges A R et al.. Deep vein thrombosis after elective knee surgery: an incidence study in 312 patients.  J Bone Joint Surg Br. 1989;  71 492-497
• 51 Jorgensen J O, Lalak N J, North L, Hanel K, Hunt D R, Morris D L. Venous stasis during laparoscopic cholecystectomy.  Surg Laparosc Endosc. 1994;  4 128-133
• 52 Sobolewski A P, Deshmukh R M, Brunson B L et al.. Venous hemodynamic changes during laparoscopic cholecystectomy.  J Laparoendosc Surg. 1995;  5 363-369
• 53 Nguyen N T, Owings J T, Gosselin R et al.. Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass.  Arch Surg. 2001;  136 909-916
• 54 Rahr H B, Fabrin K, Larsen J L, Thorlacius-Ussing O. Coagulation and fibrinolysis during laparoscopic cholecystectomy.  Thromb Res. 1999;  93 121-127
• 55 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
• 56 Goldhaber S Z, Savage D D, Garrison R J et al.. Risk factors for pulmonary embolism: the Framingham study.  Am J Med. 1983;  74 1023-1028
• 57 Lindblad B, Sternby N H, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years.  BMJ. 1991;  302 709-711
• 58 Baglin T P, White K, Charles A. Fatal pulmonary embolism in hospitalised medical patients.  J Clin Pathol. 1997;  50 609-610
• 59 Bouthier J. The venous thrombotic risk in nonsurgical patients.  Drugs. 1996;  52(suppl) 16-29
• 60 Goldhaber S Z, Dunn K, MacDougall R C. New onset of venous thromboembolism among hospitalized patients at Brigham and Women's Hospital is caused more often by prophylaxis failure than by withholding treatment.  Chest. 2000;  118 1680-1684
• 61 Blom J W, Doggen C J, Osanto S, Rosendaal F R. Malignancies, prothrombotic mutations, and the risk of venous thrombosis.  JAMA. 2005;  293 715-722
• 62 Otten H M, Prins M H. Venous thromboembolism and occult malignancy.  Thromb Res. 2001;  102 V187-V194
• 63 Sorensen H T, Mellemkjaer L, Olsen J H, Baron J A. Prognosis of cancers associated with venous thromboembolism.  N Engl J Med. 2000;  343 1846-1850
• 64 Otten H M, Mathijssen J, ten Cate H et al.. Symptomatic venous thromboembolism in cancer patients treated with chemotherapy. An underestimated phenomenon.  Arch Intern Med. 2004;  164 190-194
• 65 Macklon N S, Greer I A. Venous thromboembolic disease in obstetrics and gynaecology: the Scottish experience.  Scott Med J. 1996;  41 83-86
• 66 Athrash H K, Koonin L M, Lawson H W, Franks A L, Smith J C. Maternal morbidity in the United States 1979-1986.  Obstet Gynecol. 1990;  76 1055-1060
• 67 Hogberg U, Innala E, Sandstrom A. Maternal mortality in Sweden.  Obstet Gynecol. 1995;  84 240-244
• 68 James K, Lohr J, Deshmukh R. Venous thrombotic complications of pregnancy.  Cardiovasc Surg. 1996;  4 777-782
• 69 Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: an 11 year review.  Am J Obstet Gynecol. 1991;  164 286 (abst)
• 70 Eldor A. The use of low molecular weight heparin for the management of venous thromboembolism in pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2002;  104 3-13
• 71 Bazzan M, Donvito V. Low molecular weight heparin during pregnancy.  Thromb Res. 2001;  101 V175-V186
• 72 Rosendaal F R, Van Hylckama Vlieg A, Tanis B C, Helmerhorst F M. Estrogens, progestogens and thrombosis.  J Thromb Haemost. 2003;  1 1371-1380
• 73 Nelson H D, Humphrey L L, Nygren P, Teutsch S M, Allan J D. Postmenopausal hormone replacement therapy: scientific review.  JAMA. 2002;  288 872-881
• 74 Samama M M, Dahl O E, Mismetti P et al.. Individualizing the risk of venous thromboembolism in medical and surgical patients: development of the decision matrix for VTE prophylaxis.  J Thromb Haemost. 2003;  1(suppl 1) OC436 (abst)
• 75 Samama M M, Dahl O E, Quinlan D J, Mismetti P, Rosencher N. Quantification of risk factors for venous thromboembolism: a preliminary study for the development of a risk assessment tool.  Haematologica. 2003;  88 1410-1421
• 76 Cohen A T, Alikhan R, Arcelus J et al.. A risk assessment model for identifying medical patients who should receive thombopropylaxis.  J Thromb Haemost. 2003;  1(suppl 1) OC437 (abst)