Chapter Three
Venous Disease Coalition
Epidemiology of VTE
Risks, Risk Factors
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Thromboembolic Disorders
• 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
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Thromboembolic Disorders
• 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
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Who Is This?
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Dan Blocker (Hoss Cartright)
• Of the hit TV show, Bonanza
• Died of pulmonary embolism after gall bladder surgery
• Age 43
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Who Is This?
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General George S. Patton
• 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
“May God have mercy on my
enemies, because I won’t.”
• Age 60
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Which of these politicians
have had blood clots?
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All of them had a blood clot!
Dick Cheney
Vice President
2001-2009
Dan Quayle
Vice President
1989-1993
Richard Nixon
President
1969-1974
Jesse Ventura
Gov. of Minnesota
1999-2003
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Hillary Clinton
Secretary of State
2009-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)
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• Previous DVT or PE
• Increased age
• Estrogen use (BCP, HRT),
pregnancy, postpartum
• Central venous lines
• Blood clotting disorders
(thrombophilia)
VTE Risk Increases with Age
Residents of Worcester, MA
Anderson - Arch Intern Med 1991;151:933
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Population Attributable Risk for VTE
Risk factor
Adjusted AR
Hospitalization with surgery
Hospitalization without surgery
Active cancer
Nursing home
Trauma
Prior CVC or pacemaker
Neurologic disease with leg paresis
(case-control study/adjusted for age, sex, year)
Heit - Arch Intern Med 2002;162:1245
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24%
22%
18%
13%
12%
9%
7%
Symptomatic VTE after Surgery
• California Patient Discharge Database (N = 1,653,275)
• VTE during surgical admission or within 3 months
• Thromboprophylaxis data was not available
Malignant disease
Benign disease
Hip replacement
Craniotomy
Knee replacement
Coronary bypass
Colectomy
Hysterectomy
TUR prostate
Lap. Cholecystectomy
2.4%
2.3%
1.7%
1.1%
1.1%
0.3%
0.3%
0.2%
Craniotomy
Colectomy
Pneumonectomy
Rad. Prostatectomy
Hysterectomy
Mastectomy
White - Thromb Haemost 2003;90:446
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3.6%
1.7%
1.6%
1.5%
1.2%
0.4%
Postoperative VTE is Associated
With Increased Mortality
• 118,258 surgical patients in 120 VA hospitals
VTE
No
Yes
30-day
Mortality
4.4%
p<0.0001
16.9%
• Symptomatic VTE is associated with significantly
increased 30-day mortality
Gangireddy - J Vasc Surg 2007;45:335
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Recurrent VTE is Common
VTE is often a chronic disease
30 %
25 %
Cumulative
Frequency
of Recurrent
VTE
20 %
15 %
10 %
5%
0
1
2 3 4 5 6 7
Years Since Index DVT
Prandoni - Ann Intern Med 1996;125:1
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8
Post-Thrombotic Syndrome is Common
 Prospective study of 355 patients with DVT
 All patients advised to wear 40 mmHg stockings
35%
30%
25%
Cumulative
20%
Frequency of PTS
15%
10%
5%
0%
1
2
3 4 5 6
Years Since DVT
Pradoni – Ann Intern Med 1996; 125:1
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7
8
Venous Disease Coalition
www.vasculardisease.org/venousdiseasecoalition/
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