Epidemiology and socioeconomic consequences of venous thromboembolism

ESC CardioMed ◽  
2018 ◽  
pp. 2747-2751
Author(s):  
Alexander T. Cohen ◽  
Marjolein P. A. Brekelmans ◽  
Carlos Martinez
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Recurrent Events ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Incidence Rates ◽  
Post Thrombotic Syndrome ◽  
Disease Associations ◽  
Thromboembolic Pulmonary Hypertension ◽  
Surgical Conditions ◽  
Socioeconomic Consequences

Venous thromboembolism (VTE) is a common disease with numerous well-characterized risk factors and many different clinical manifestations. There is great variation in the epidemiology and socioeconomic impact depending on the disease associations and the site of the thrombosis. The regional rates vary and in Western countries the incidence rate for first events is in the order of 100–250 per 100,000 person-years, attack rates (new and recurrent events) are about 250 per 100,000 person-years. The annual prevalence (a cross-sectional view) is about 400 per 100,000 population. Following hospitalization for medical or surgical conditions, the rates are higher and these events contribute to around half the population attributable risk. During periods of active cancer the incidence rates are very high. Post-thrombotic syndrome complicates 20–50% of deep vein thrombosis cases and is severe in 5–10%. Chronic thromboembolic pulmonary hypertension contributes significantly to the burden of VTE. Around 0.4–4% of patients with pulmonary embolism will eventually develop chronic thromboembolic pulmonary hypertension. Incidence rates for first episodes and attack rates have been widely studied, but incidence rates of recurrent events, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension have not and generally only the cumulative incidence has been characterized. VTE mortality is significant particularly in the first 3 months, following that it is strongly related to the underlying diseases. The socioeconomic consequences of VTE are significant with respect to disability and costs.

Epidemiology and socioeconomic consequences of venous thromboembolism

ESC CardioMed ◽  
2018 ◽  
pp. 2747-2751
Author(s):  
Alexander T. Cohen ◽  
Anne-Céline Martin ◽  
Carlos Martinez
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Recurrent Events ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Incidence Rates ◽  
Post Thrombotic Syndrome ◽  
Disease Associations ◽  
Thromboembolic Pulmonary Hypertension ◽  
Surgical Conditions ◽  
Socioeconomic Consequences

Venous thromboembolism (VTE) is a common disease with numerous well-characterized risk factors and many different clinical manifestations. There is great variation in the epidemiology and socioeconomic impact depending on the disease associations and the site of the thrombosis. The regional rates vary and in Western countries the incidence rate for first events is in the order of 100–250 per 100,000 person-years, attack rates (new and recurrent events) are about 250 per 100,000 person-years. The annual prevalence (a cross-sectional view) is about 400 per 100,000 population. Following hospitalization for medical or surgical conditions, the rates are higher and these events contribute to around half the population attributable risk. During periods of active cancer the incidence rates are very high. Post-thrombotic syndrome complicates 20–50% of deep vein thrombosis cases and is severe in 5–10%. Chronic thromboembolic pulmonary hypertension contributes significantly to the burden of VTE. Around 0.4–4% of patients with pulmonary embolism will eventually develop chronic thromboembolic pulmonary hypertension. Incidence rates for first episodes and attack rates have been widely studied, but incidence rates of recurrent events, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension have not and generally only the cumulative incidence has been characterized. VTE mortality is significant particularly in the first 3 months, following that it is strongly related to the underlying diseases. The socioeconomic consequences of VTE are significant with respect to disability and costs.

scholarly journals Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism

2017 ◽  
Vol 49 (5) ◽  
pp. 1601980 ◽  
Author(s):  
Raffaele Pesavento ◽  
Lucia Filippi ◽  
Antonio Palla ◽  
Adriana Visonà ◽  
Carlo Bova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
First Episode ◽  
Long Term Outcome ◽  
Recurrent Venous Thromboembolism ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Impact ◽  
Lung Scanning

The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain.We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis. They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years. Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria.Residual pulmonary obstruction was detected in 324 patients (50.1%, 95% CI 46.2–54.0%). Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode. After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (10.5%) with residual pulmonary obstruction and in 15 out of the 323 patients (4.6%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16).Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension.

scholarly journals Association Between Anticoagulation Outcomes and Venous Thromboembolism History in Chronic Thromboembolic Pulmonary Hypertension

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Jian Zhu ◽  
Yu-Ping Zhou ◽  
Yun-Peng Wei ◽  
Xi-Qi Xu ◽  
Xin-Xin Yan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Prior History ◽  
Anticoagulation Treatment ◽  
Increased Risk ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Recurrent Vte ◽  
Potential Factors

Background: The association between anticoagulation outcomes and prior history of venous thromboembolism (VTE) in chronic thromboembolic pulmonary hypertension (CTEPH) has not been established. This study aimed to compare the efficacy and safety of anticoagulation treatment in CTEPH patients with and without prior history of VTE.Methods: A total of 333 CTEPH patients prescribed anticoagulants were retrospectively included from May 2013 to April 2019. The clinical characteristics were collected at their first admission. Incidental recurrent VTE and clinically relevant bleeding were recorded during follow-up. The Cox proportional regression models were used to identify potential factors associated with recurrent VTE and clinically relevant bleeding.Results: Seventy patients (21%) without a prior history of VTE did not experience recurrent VTE during anticoagulation. Compared to CTEPH patients without a prior history of VTE, those with a prior history of VTE had an increased risk of recurrent VTE [2.27/100 person-year vs. 0/100 person-year; hazard ratio (HR), 8.92; 95% confidence interval (CI), 1.18–1142.00; P = 0.029] but a similar risk of clinically relevant bleeding (3.90/100 person-year vs. 4.59/100 person-year; HR, 0.83; 95% CI, 0.38–1.78; P = 0.623). Multivariate Cox analyses suggested that a prior history of VTE and interruption of anticoagulation treatments were significantly associated with an increased risk of recurrent VTE, while anemia and glucocorticoid use were significantly associated with a higher risk of clinically relevant bleeding.Conclusions: This study is the first to reveal that a prior history of VTE significantly increases the risk of recurrent VTE in CTEPH patients during anticoagulation treatment. This finding should be further evaluated in prospective studies.

scholarly journals Real-life data of direct anticoagulant use, bleeding risk and venous thromboembolism recurrence in chronic thromboembolic pulmonary hypertension patients: an observational retrospective study

2020 ◽  
Vol 10 (1) ◽  
pp. 204589401987354 ◽  
Author(s):  
Sert Sena ◽  
Mutlu Bulent ◽  
Kocakaya Derya ◽  
Kaptan Deniz ◽  
Ataş Halil ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Real Life ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Bleeding Events ◽  
Warfarin Group ◽  
Thromboembolic Pulmonary Hypertension ◽  
Recurrent Vte

Introduction Lifelong anticoagulation is the cornerstone of the chronic thromboembolic pulmonary hypertension (CTEPH) treatment regardless of the additional pulmonary endarterectomy, balloon pulmonary angioplasty, or medical treatment alone. Aim of this study was to evaluate the rate of oral anticoagulant preferences and document direct oral anticoagulants’ (DOACs’) safety, efficacy in the CTEPH population. Methods Patients’ demographic data obtained from database between September 2011 and April 2018. In-hospital events, death, venous thromboembolism (VTE) recurrence, bleeding events and anticoagulant therapy transition were recorded. Results We reviewed 501 CTEPH patients who observed 9.0 ± 8.5 years. All-cause death, all bleeding, recurrent VTE was observed in 15.6%, 31% and 12%. Forty-one patients (8.2%) were diagnosed as inoperable. Of all, 15.2% of operable patients remained as residual. All-cause mortality rates were 13.8% (57 pts.) in the warfarin group as compared with 9.7% (13 pts.) in rivaroxaban group (HR: 1.61, 95% CI, 0.89–2.99; p: 0.11). Higher bleeding events occurred with warfarin group (27.1%) as compared with rivaroxaban (24.6%; HR: 1.28, 95% CI, 0.86–1.88; p: 0.22). Major bleeding was significantly higher with warfarin group (HR: 1.94, 95% CI, 1.05–3.62; p: 0.03). Subgroup analysis of all-cause death revealed that this significance dominated by the rate of death according to bleeding events; warfarin versus those seen with rivaroxaban (4.85% vs. 2.2%; HR: 4.75, 95% CI: 1.12–20.16; p = 0.03). The rate of recurrent VTE was found 8.9% in the rivaroxaban group, 10.9% in warfarin group (HR: 1.21, 95% CI, 0.64–2.23; p: 0.55). Conclusion DOACs could be a safe and effective alternative for lifelong anticoagulant therapy in CTEPH patients. Rivaroxaban produced similar rates of thromboembolism and non-relevant bleeding compared to those associated with warfarin. The main difference was found with major bleeding that it was mainly associated with the death rate according to major bleeding. Using DOACs might be a more reasonable way to prevent bleeding events without increasing thromboembolic risk.

Factors associated with diagnosis and operability of chronic thromboembolic pulmonary hypertension

2013 ◽  
Vol 110 (07) ◽  
pp. 83-91 ◽  
Author(s):  
Gérald Simonneau ◽  
Joanna Pepke-Zaba ◽  
Eckhard Mayer ◽  
David Ambrož ◽  
Isabel Blanco ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Venous Thromboembolism ◽  
Univariate Analysis ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Factors Associated ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Acute Venous Thromboembolism

SummaryChronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary hypertension (IPAH) share a similar clinical presentation, and a differential diagnosis requires a thorough workup. Once CTEPH is confirmed, patients who can be safely operated have to be identified. We investigated risk factors associated with CTEPH and IPAH, and the criteria for the selection of operable CTEPH patients. This case-control study included 436 consecutive patients with CTEPH and 158 with IPAH in eight European centres, between 2006 and 2010. Conditions identified as risk factors for CTEPH included history of acute venous thromboembolism (p < 0.0001), large size of previous pulmonary embolism (p = 0.0040 in univariate analysis), blood groups non-O (p < 0.0001 in univariate analysis), and older age (p = 0.0198), whereas diabetes mellitus (p = 0.0006), female gender (p = 0.0197) and higher mean pulmonary artery pressure (p = 0.0103) were associated with increased likelihood for an IPAH diagnosis. Operability of CTEPH patients was associated with younger age (p = 0.0108), proximal lesions (p ≤ 0.0001), and pulmonary vascular resistance below 1200 dyn.s.cm-5 (p = 0.0080). Non-operable CTEPH patients tended to be less differentiable from IPAH patients by risk factor analysis than operable patients. This study confirmed the association of CTEPH with history of acute venous thromboembolism and blood groups non-O, and identified diabetes mellitus and higher mean pulmonary artery pressure as factors suggesting an IPAH diagnosis. Non-operable CTEPH is more similar to IPAH than operable CTEPH regarding risk factors.

scholarly journals The anticoagulant effects of warfarin and the bleeding risk associated with its use in patients with chronic thromboembolic pulmonary hypertension at a specialist center in Japan: a retrospective cohort study

2017 ◽  
Vol 7 (3) ◽  
pp. 684-691 ◽  
Author(s):  
Takayuki Jujo-Sanada ◽  
Nobuhiro Tanabe ◽  
Seiichiro Sakao ◽  
Toshihiko Sugiura ◽  
Ayumi Sekine ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Bleeding Risk ◽  
Incidence Rates ◽  
Pulmonary Endarterectomy ◽  
Bleeding Events ◽  
Thromboembolic Pulmonary Hypertension ◽  
Recurrent Vte ◽  
Clinical Records ◽  
Observation Period

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong anticoagulation therapy. However, the bleeding risk and recurrence of venous thromboembolism (VTE) in CTEPH patients who are administered warfarin have not been adequately evaluated. The purpose of this study was to evaluate the risk of clinically relevant bleeding, recurrent VTE, and clinical worsening in patients with CTEPH who were administered warfarin. The clinical records of 72 patients with CTEPH who regularly visited our institution and were administered warfarin were retrospectively reviewed between 1 January 2011 and 31 December 2015. We investigated the incidence of clinically relevant bleeding events, recurrent VTE, and hospitalization for the deterioration of pulmonary hypertension or right heart failure (RHF) during the observation period. The mean observation period for the 72 patients was 3.60 ± 1.60 person-years. Clinically relevant bleeding, RHF, and recurrent VTE occurred in 21 (29.2%), eight (11.1%), and three (4.2%) of 72 patients, respectively, and the incidence rates for these events were 8.1%/person-year, 3.1%/person-year, and 1.2%/person-year, respectively. The incidence rates for the major and non-major bleeding events were 5.0%/person-year and 3.9%/person-year, respectively. The incidence of clinically relevant bleeding events was 20.8%/person-year during medical treatment with a soluble guanylate cyclase stimulator. One of 35 patients (2.9%) during the post-pulmonary endarterectomy period experienced hemoptysis during observation period (> 6 months after pulmonary endarterectomy). No bleeding events occurred during the post-balloon pulmonary angioplasty period. In conclusion, warfarin effectively prevents VTE recurrence in CTEPH patients, but its effects may be associated with a considerable bleeding risk.

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