The Epidemiology of Venous Thromboembolism in the Community

2001 ◽  
Vol 86 (07) ◽  
pp. 452-463 ◽  
Author(s):  
David Mohr ◽  
Tanya Petterson ◽  
Christine Lohse ◽  
W. Michael O’Fallon ◽  
L. Joseph Melton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Varicose Veins ◽  
Hormone Replacement ◽  
Malignant Neoplasm ◽  
Venous Catheter ◽  
The United States ◽  
Venous Stasis ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis

SummaryThe 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 pulmonary embolism. Despite improved prophylaxis, the incidence of venous thromboembolism has been constant since 1980. Independent risk factors for venous thromboembolism include increasing age, male gender, surgery, trauma, hospital or nursing home confinement, malignancy, neurologic disease with extremity paresis, central venous catheter/ transvenous pacemaker, prior superficial vein thrombosis, and varicose veins; among women, risk factors include pregnancy, oral contraceptives, and hormone replacement therapy. About 30% of surviving cases develop recurrent venous thromboembolism within ten years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm, and extremity paresis. About 28% of cases develop venous stasis syndrome within 20 years. To reduce venous thromboembolism incidence, improve survival, and prevent recurrence and complications, patients with these characteristics should receive appropriate prophylaxis.

Risk Factors and Epidemiology of Pulmonary Embolism

2020 ◽  
Author(s):  
Aaron B Waxman ◽  
Aaron W Aday
Keyword(s):  
United States ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Recurrent Events ◽  
Hormone Replacement ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deep Vein

More than 200,000 individuals are hospitalized with an acute pulmonary embolism in the United States annually. Despite advances in diagnosis and treatment, pulmonary embolism accounts for nearly 1% of all cardiovascular-related deaths each year in the United States alone. Those who survive an acute episode remain at a risk of recurrent events as well as ongoing dyspnea, reduced quality of life, and chronic thromboembolic pulmonary hypertension. Recognized risk factors for pulmonary embolism include advanced age, obesity, smoking, malignancy, immobilization from any cause, pregnancy and the postpartum period, oral contraceptives, and hormone replacement therapy. Numerous heritable and acquired thrombophilias increase the risk of pulmonary embolism. Additionally, inflammation and autoimmune disorders are increasingly recognized as potent risk factors for pulmonary embolism. This review contains 3 figures, 6 tables, 54 references. Key Words: anticoagulation, deep vein thrombosis, epidemiology, genetics, inflammation, malignancy, pulmonary embolism, thrombosis, venous thromboembolism

scholarly journals Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival

Blood ◽  
2009 ◽  
Vol 113 (17) ◽  
pp. 3911-3917 ◽  
Author(s):  
Grace H. Ku ◽  
Richard H. White ◽  
Helen K. Chew ◽  
Danielle J. Harvey ◽  
Hong Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Leukemia ◽  
Lymphoblastic Leukemia ◽  
Venous Catheter ◽  
Population Based ◽  
Older Age ◽  
Myelogenous Leukemia ◽  
Vein Thrombosis ◽  
Chronic Comorbidities

Abstract A population-based cohort was used to determine the incidence and risk factors associated with development of venous thromboembolism (VTE) among Californians diagnosed with acute leukemia between 1993 to 1999. Principal outcomes were deep vein thrombosis in both the lower and upper extremities, pulmonary embolism, and mortality. Among 5394 cases with acute myelogenous leukemia (AML), the 2-year cumulative incidence of VTE was 281 (5.2%). Sixty-four percent of the VTE events occurred within 3 months of AML diagnosis. In AML patients, female sex, older age, number of chronic comorbidities, and presence of a catheter were significant predictors of development of VTE within 1 year. A diagnosis of VTE was not associated with reduced survival in AML patients. Among 2482 cases with acute lymphoblastic leukemia (ALL), the 2-year incidence of VTE in ALL was 4.5%. Risk factors for VTE were presence of a central venous catheter, older age, and number of chronic comorbidities. In the patients with ALL, development of VTE was associated with a 40% increase in the risk of dying within 1 year. The incidence of VTE in acute leukemia is appreciable, and is comparable with the incidence in many solid tumors.

Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 584-584
Author(s):  
Frederick A. Spencer3 ◽  
Robert J. Goldberg ◽  
Darleen Lessard ◽  
Cathy Emery ◽  
Apar Bains ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Central Venous Catheter ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Central Venous ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

Risk Factors and Epidemiology of Pulmonary Embolism

2020 ◽  
Author(s):  
Aaron B Waxman ◽  
Aaron W Aday
Keyword(s):  
United States ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Recurrent Events ◽  
Hormone Replacement ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
The United States ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
Deep Vein

More than 200,000 individuals are hospitalized with an acute pulmonary embolism in the United States annually. Despite advances in diagnosis and treatment, pulmonary embolism accounts for nearly 1% of all cardiovascular-related deaths each year in the United States alone. Those who survive an acute episode remain at a risk of recurrent events as well as ongoing dyspnea, reduced quality of life, and chronic thromboembolic pulmonary hypertension. Recognized risk factors for pulmonary embolism include advanced age, obesity, smoking, malignancy, immobilization from any cause, pregnancy and the postpartum period, oral contraceptives, and hormone replacement therapy. Numerous heritable and acquired thrombophilias increase the risk of pulmonary embolism. Additionally, inflammation and autoimmune disorders are increasingly recognized as potent risk factors for pulmonary embolism. This review contains 3 figures, 6 tables, 54 references. Key Words: anticoagulation, deep vein thrombosis, epidemiology, genetics, inflammation, malignancy, pulmonary embolism, thrombosis, venous thromboembolism

Venous thromboembolism

2020 ◽  
pp. 363-372
Author(s):  
Charlotte Frise ◽  
Sally Collins
Keyword(s):  
Risk Factors ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Superficial Vein ◽  
Mortality And Morbidity ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis ◽  
Maternal Mortality And Morbidity ◽  
Deep Vein

Venous thromboembolism is a major cause of maternal mortality and morbidity. This chapter discusses thromboprophylaxis (including low-molecular-weight heparin and doses by patient weight), risk factors, deep vein thrombosis, pulmonary embolism, associated investigations, and management. Anticoagulants and bleeding while anticoagulated are both covered. Finally, superficial vein thrombosis in the first month postpartum is described.

scholarly journals Hospital Associated Venous Thromboembolism in Oklahoma County

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 416-416 ◽  
Author(s):  
Natalie Feland ◽  
Aaron Mark Wendelboe ◽  
Micah Denay McCumber ◽  
Kai Ding ◽  
Dale Bratzler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Hospital Stay ◽  
Significant Proportion ◽  
Population Based ◽  
Adverse Outcomes ◽  
Vein Thrombosis ◽  
University Of Oklahoma ◽  
Superficial Vein Thrombosis ◽  
Risk Factor Data

Abstract Introduction: Venous thromboembolism (VTE) is a leading cause of death and disability of the adverse outcomes associated with a hospital stay among low, middle, and high income countries evaluated by the WHO Patient Safety Program. Objective: Compare characteristics and risk factors for hospital associated and non-hospital associated cases of VTE in Oklahoma County from April 1, 2012 to March 31, 2014. Methods: In collaboration with the Centers for Disease Control and Prevention (CDC), a population-based surveillance system for VTE was established in Oklahoma County, OK between April 1, 2012-March 31, 2014 to estimate the incidences of first-time and recurrent VTE events. The Commissioner of Health made VTE a reportable condition and delegated surveillance-related responsibilities to the University of Oklahoma, College of Public Health. Active surveillance involved reviewing imaging studies (e.g., chest computed tomography and compression ultrasounds of the extremities) from all inpatient and outpatient facilities in the county and collecting demographic, treatment and risk factor data on all VTE case-patients. Hospital associated VTE is defined as a VTE diagnosis made either during the hospital stay or within 90 days of hospital admission, regardless of the reason for hospitalization. Odds ratios and 95% confidence intervals (CI) were calculated. Those age 80+ years were used as the referent age group. Comparisons between hospital associated and non-hospital associated VTE cases were made by using two-sided χ2tests. Results: We identified 2,737 patients with imaging-confirmed VTE. Of these, 1,223 (44.7%) cases were identified as hospital associated and 1,514 (55.3%) cases as non-hospital associated VTE. Of the hospital associated VTE cases, 863 (70.6%) had VTE diagnosed while hospitalized and 360 (29.4%) were diagnosed VTE as outpatients after hospital discharge; of these 360 cases, 239 (66.4%) were re-admitted to the hospital and 121 (33.6%) were managed as outpatients. Of the non-hospital associated VTE cases, 776 (51.3%) were admitted to the hospital after diagnosis and 738 (48.7%) were treated as outpatients. The median length of stay for hospital-associated cases was 8 days (range 1-206 days). The distribution of PE (p = 0.17) and DVT (p = 0.07) were similar in hospital associated cases and non-hospital associated cases. The distributions of race (p = 0.34) and sex (p = 0.17) were similar for patients with and without hospital associated VTE; however, hospital associated cases of VTE tended to be older than non-hospital associated cases (p<0.01; 18-39 years OR = 1.7, 95% CI 1.2-2.2, 40-49 years OR = 1.8, 95% CI 1.3-2.4, 50-59 years OR = 1.3, 95% CI 1.0-1.7, 60-69 years OR = 1.1, 95% CI 0.84-1.4, 70-79 years OR = 1.2, 95% CI 0.91-1.5). Venous catheterization in the last 6 months (OR= 4.4, 95% CI 3.4-5.7), surgery (OR = 3.4, 95% CI 2.8-4.0) and trauma (OR = 3.0, 95% CI 2.3-3.9) in the last 12 months, and histories of: congestive heart failure (OR = 2.6, 95% CI 2.0-3.3), stroke (OR = 2.6, 95% CI 1.9-3.6), myocardial infarction (OR = 2.2, 95% CI 1.6-3.1), superficial vein thrombosis (OR = 1.8, 95% CI 1.3-2.5), and cancer (OR = 1.5, 95% CI 1.3-1.8) were risk factors for hospital associated cases of VTE. Hospital associated VTE cases had 3.5 times the odds of death (95% CI 2.4-5.0) than non-hospital associated cases. Discussion: A significant proportion (45%) of the total VTE burden continues to be hospital associated. A substantial proportion of hospital associated cases are diagnosed after discharge and result in re-admission, with the potential for significant financial penalties under Medicare value-based payment programs. Hospital associated cases of VTE were older, had more risk factors, and were more likely to die than non-hospital associated cases. Disclosures Raskob: Bayer Healthcare: Consultancy; BMS: Consultancy; Daiichi Sankyo: Consultancy; Janssen Pharmaceuticals: Consultancy; Pfizer: Consultancy; ISIS Pharmaceuticals: Consultancy.

High Incidence of Venous Thromboembolism in Patients with Lymphoma Receiving Chemotherapy: Assessment of Risk Factors.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4103-4103
Author(s):  
Shyam Teegala ◽  
Xiao Zhou ◽  
Auris Huen ◽  
Yuan Ji ◽  
Luis Fayad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multivariate Logistic Regression Analysis ◽  
Venous Catheter ◽  
Large Cell ◽  
Cycle Number ◽  
Vein Thrombosis ◽  
Significant Independent Risk Factor ◽  
Increased Risk ◽  
Risk Patients

Abstract Background: Venous thromboembolism (VTE) is a significant cause of cancer morbidity and mortality. Lymphoma patients (pts) are at increased risk of VTE, however, the exact incidence and risk factors are unknown. Methods: Of the 1050 newly referred Lymphoma pts to MDACC in 2003 identified, medical records (MR) of 538 consecutive pts were reviewed for demographics, tumor histology, staging, laboratory values, type of chemotherapy (CT) regimens, risk factors for VTE, incidence of VTE and management over a follow up of 2 years. Results: 207 out of 538 pts received at least one cycle of CT at MDACC (total CT cycles 1125). The median age was 56 years (range 17–82); there were 81 females and 126 males. Majority of pts (61.8%) were newly diagnosed and the most common histologies were Large Cell Lymphoma (31.88%), followed by Hodgkin’s Disease (16.9%) and Follicular Lymphoma (14.98%). Thirteen out of 207 (6.28%) pts had history of VTE prior to CT and 37 (17.9 %) pts out of 207 had 41 new episodes of VTE; 29 Deep Vein Thrombosis (DVT) (12 upper and 12 lower extremity) and 12 Pulmonary Embolism (PE); 2 pts had both DVT and PE. All VTE episodes were confirmed by imaging except in 3 pts. The mean baseline hemoglobin (Hb) in VTE pts was 12.8 g/dL. The median cycle number for VTE occurrence was cycle 3 with 24/37 (64.86%) pts experiencing VTE by cycle 3 and 6/37 (16.2%) pts had VTE in cycle 1. Two out of the 37 (5.4%) pts had recurrent VTE. Among those with new VTE, 31/37 (83.78%) pts were of age greater than 40, 25/37 (67.56%) pts had BMI &gt; 25, 32/37 (86.4%) pts had aggressive or highly aggressive histology and 29/37 (78.37%) pts had stage 3 or 4 disease. Twenty-three out of 31 (74.2%) pts had received erythropoietin before or during the cycle of VTE. Fourteen of 207 (6.79%) pts were on thromboprophylaxis before the chemotherapy. Only 1 of these 14 pts experienced VTE, approximately 2 months after the discontinuation of prophylaxis. Central venous catheter (CVC) thrombosis occurred in 6/174 (3.44%) patients with CVC. The most common systemic treatment for VTE was Enoxaparin (12/33). By multivariate logistic regression analysis of many of the previously described risk factors and other variables, Doxorubicin and/or Methotrexate based CT regimen was found to be a significant independent risk factor for VTE (OR 5.58, 95%CI 1.62 to 19.13. p = 0.0062). Conclusion: VTE is a frequent and underestimated complication in Lymphoma pts. These findings underscore the importance of prospective clinical trials of anticoagulation prophylaxis in the high risk patients receiving CT.

Diagnosis and treatment of superficial vein thrombosis

2013 ◽  
Vol 33 (03) ◽  
pp. 232-240 ◽  
Author(s):  
R. M. Bauersachs
Keyword(s):  
Risk Factors ◽  
Varicose Veins ◽  
Epidemiological Data ◽  
Clinical Findings ◽  
Common Disease ◽  
Superficial Vein ◽  
Thromboembolic Complications ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Superficial Vein Thrombosis

SummarySuperficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory- thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebocontrolled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.

Abstract 336: Prevalence and Risk Factors for Idiopathic Venous Thromboembolism

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Patricia Yau ◽  
Thomas Maldonado ◽  
Juanita Erb ◽  
Neel Ranganath ◽  
Caroline Sindet-Pederson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Prediction Models ◽  
Varicose Veins ◽  
Medical Center ◽  
The United States ◽  
Major Surgery ◽  
High Risk Population ◽  
Female Sex ◽  
History Of

Introduction: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the United States. Despite medical advances in diagnostics and thromboprophylaxis, the incidence of VTE has not substantially decreased over time. Furthermore, many patients are diagnosed with VTE without an identifiable cause. Objectives: We sought to investigate the prevalence of idiopathic VTE and risk factors associated with this diagnosis. Methods: Patients diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) were enrolled into a prospective venous thromboembolic center (VTEC) registry at a large tertiary medical center from 7/2015-12/2015. VTE events were considered to be idiopathic if none of the following criteria were met: current pregnancy; current use of hormonal therapy or oral contraceptives, active malignancy; diagnosed thrombophilia; major surgery within 90 days; bed rest, restricted mobility, cast or mold, or serious trauma within 30 days. Patient demographics, comorbidities, social history, family history, laboratory and clinical data were analyzed and compared between groups. Multivariable logistic regression analysis was used to estimate odds of idiopathic VTE. Results: Of 223 patients with VTE, 93 (41.7%) were determined to be idiopathic. Patients with idiopathic and non-idiopathic VTE were of similar age, race/ethnicity, level of education, type of insurance, and type of VTE (DVT or PE). Patients with idiopathic VTE were more frequently female (68.8% vs. 46.4%; p < 0.01), more likely to have a history of COPD (8.6% vs. 1.1%, p = 0.03), hyperlipidemia (33.6% vs. 18.3%, p = 0.02), and less likely to be on a statin at the time of diagnosis (17.2% vs. 29.3%, p = 0.05) than non-idiopathic VTE. After multivariable adjustment, female sex (OR: 2.47, 95% CI 1.35-4.64) and history of varicose veins (OR 2.67, 95% CI 1.15-6.37) were significantly associated with the prevalence of idiopathic VTE. Conclusions: In a large tertiary medical center, idiopathic VTE occurred in more than 40% of all VTEs. Female sex and history of varicose veins were independently associated with having an idiopathic VTE. These data provide a basis for future investigation into this high-risk population and for further development of prediction models.

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