Epidemiology of venous thromboembolism

Abstract

Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and-in women-pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing.

Figure 1

Annual incidence of venous thromboembolism among residents of Olmsted County, MN, USA, from 1966 to 1990, by age and sex. Permission obtained from the American Medical Association © Silverstein, M. D. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch. Intern. Med. 158, 585–593 (1998).

Figure 2

Annual incidence of venous thromboembolism among residents of Olmsted County, MN, USA, from 1966 to 1990, by age. The overall incidence of venous thromboembolism is shown, along with the incidence of deep-vein thrombosis alone, and pulmonary embolism (with or without deep-vein thrombosis). Permission obtained from the American Medical Association © Silverstein, M. D. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch. Intern. Med. 158, 585–593 (1998).

Figure 3

Trends over time in the incidence of venous thromboembolism, deep-vein thrombosis alone, and pulmonary embolism (with or without deep-vein thrombosis) among residents of Worcester, MA, USA. Permission obtained from Elsevier © Huang, W. et al. Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985–2009). Am. J. Med. 127, 829–839 (2014).

Figure 4

Kaplan–Meier estimates of survival among residents of Olmsted County, MN, USA with incident venous thromboembolism diagnosed 1966–1990. Pulmonary embolism includes cases with or without deep-vein thrombosis, where pulmonary embolism was the cause of death.