Chapter ThreeVenous Disease Coalition

Epidemiology of VTERisks, Risk Factors

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Thromboembolic Disorders

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• Acute coronary syndrome, ischemic or cardioembolic stroke, venous thromboembolic disease, acute limb ischemia

• Acute vascular diseases are the commonest cause of death

• VTE (DVT, PE) 3rd commonest vascular disease

• More deaths from PE than AIDS, breast cancer and motor vehicle crashes combined

• Risk of VTE increases with age

Thromboembolic Disorders

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• Affects approximately 1/1,000 people annually

• DVT alone accounts for 300,000–600,000 hospitalizations each year in the USA

• PE causes nearly 200,000 deaths per year in the USA

• Major costs of diagnosis, treatment

Who Is This?

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Dan Blocker (Hoss Cartright)

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• Of the hit TV show, Bonanza• Died of pulmonary embolism after gall bladder

surgery• Age 43

Who Is This?

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General George S. Patton

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• One of the greatest generals of all time – “Old Blood and Guts”

• WWII commander of the US 3rd army in Europe and North Africa

• December 1945 – car accident near Heidelberg

• Died of pulmonary embolism 12 days later

• Age 60“May God have mercy on my enemies, because I won’t.”

Which of these politicianshave had blood clots?

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All of them had a blood clot!

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Dick CheneyVice President2001-2009

Jesse VenturaGov. of Minnesota1999-2003

Richard NixonPresident1969-1974

Dan QuayleVice President

1989-1993

Hillary ClintonSecretary of

State2009-present

Who is at risk for VTE?

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Risk Factors• Surgery• Trauma (major trauma

or leg injury)• Immobilization

(bedrest, stroke, paralysis)• Cancer and its

treatment (CTX, RTX, hormonal)• Acute medical illness

(heart or respiratory

failure, infection, inflammation)• Previous DVT or PE• Increased age• Estrogen use (BCP,

HRT), pregnancy, postpartum• Central venous lines • Blood clotting disorders

(thrombophilia)

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VTE Risk Increases with Age

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Residents of Worcester, MA

Anderson - Arch Intern Med 1991;151:933

Population Attributable Risk for VTE

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(case-control study/adjusted for age, sex, year)

Risk factor Adjusted AR

Hospitalization with surgery 24%

Hospitalization without surgery 22%

Active cancer 18%

Nursing home 13%

Trauma 12%

Prior CVC or pacemaker 9%

Neurologic disease with leg paresis 7%

Heit - Arch Intern Med 2002;162:1245

• California Patient Discharge Database (N = 1,653,275)• VTE during surgical admission or within 3 months

• Thromboprophylaxis data was not available

Symptomatic VTE after Surgery

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Benign disease Hip replacement

2.4% Craniotomy

2.3% Knee replacement

1.7% Coronary bypass

1.1% Colectomy

1.1% Hysterectomy

0.3% TUR prostate

0.3% Lap. Cholecystectomy

0.2%

Malignant disease Craniotomy3.6% Colectomy1.7% Pneumonectomy1.6% Rad. Prostatectomy1.5% Hysterectomy1.2% Mastectomy0.4%

White - Thromb Haemost 2003;90:446

Postoperative VTE is AssociatedWith Increased Mortality

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• 118,258 surgical patients in 120 VA hospitals

• Symptomatic VTE is associated with significantly increased 30-day mortality

Gangireddy - J Vasc Surg 2007;45:335

30-dayVTE MortalityNo 4.4%Yes 16.9%

p<0.0001

VTE is often a chronic diseaseRecurrent VTE is Common

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CumulativeFrequency of Recurrent VTE

30 %

25 %

20 %

15 %

10 %

5 %

0 1 2 3 4 5 6 7 8 Years Since Index DVT

Prandoni - Ann Intern Med 1996;125:1

Post-Thrombotic Syndrome is Common

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Prospective study of 355 patients with DVT All patients advised to wear 40 mmHg stockings

0%5%

10%15%20%25%30%35%

1 2 3 4 5 6 7 8Years Since DVT

Cumulative Frequency of PTS

Pradoni – Ann Intern Med 1996; 125:1

Venous Disease Coalition

www.vasculardisease.org/venousdiseasecoalition/

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