Current incidence of venous thromboembolism and comparison with 1998: a community-based study in Western France

Abstract

In 1998 we estimated the incidence of venous thromboembolism (VTE) to be 1.8/1,000 per year. The aim of this study was to compare current VTE incidence to that observed in 1998. We prospectively recorded all cases of symptomatic pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower limbs diagnosed between March 1, 2013 and February 28, 2014 in hospitals and in the community, using the same method and geographic area than in 1998. The 2013 incidence rates of VTE were computed and compared with those of 1998 using age- and sex-specific standardised incidence ratios (SIRs). In 2013, we recorded 576 VTE cases (279 isolated DVT and 297 PE ± DVT). Among 367,911 inhabitants, the overall incidence of VTE was 1.57/1,000 (95 % CI 1.44-1.69). The overall VTE incidence was significantly lower in 2013 as compared with 1998: SIR 0.72 (95 % CI 0.67-0.79) as well as the incidence of isolated DVT: SIR 0.53 (95 % CI 0.47-0.60); conversely, the overall incidence of PE was unchanged: SIR 1.10 (95 % CI, 0.98-1.23) despite an increase in the incidence of isolated PE: SIR 1.29 (95 % CI, 1.10-1.52). In 1998, 4.4 % of PE cases were diagnosed using CTPA as compared with 73.7 % in 2013 (p < 0.001). In conclusion, between 1998 and 2013, the incidence of symptomatic DVT decreased. Conversely, we found no similar reduction in the incidence of symptomatic PE; whether this is due to changes in diagnostic tests and algorithms in the management of suspected PE requires further investigations.

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

“…2,7 After an isolated distal DVT (infra-popliteal DVT without pulmonary embolism, referred to as distal DVT throughout this article), the risk of developing PTS and the impact of anticoagulant treatment on this risk are uncertain. As distal DVT is frequent and accounts for up to half of all lower limb DVT, [8][9][10][11] this is an important knowledge gap. Furthermore, whether distal DVT needs to be treated with therapeutic anticoagulation is still debated and anticoagulant treatment is not routinely recommended in international guidelines.…”

Current and future burden of venous thrombosis: Not simply predictable

“…Venous thrombosis is the collective term for deep vein thrombosis and pulmonary embolism, indicating the presence of a blood clot obstructing flow in the deep veins or pulmonary arteries, respectively. At an estimated incidence rate of 1‐2 per 1000 persons every year, it is the third most common cardiovascular disease and is associated with substantial short‐ and long‐term morbidity and mortality . Short‐term consequences of venous thrombosis include the absolute need for anticoagulant therapy, which is inevitably associated with an increased bleeding risk; the estimated case‐fatality rate is approximately 6% after 30 days .…”

Resolution of Deep Venous Thrombosis: Proposed Immune Paradigms

“…Regardless, recent estimates place the 1-year mortality rate following VTE in the range of 9-30%, [3,6,10,11] compared to less than 4.5% in control patients matched for age and other major risk factors [11]. The median of these current incidence (1.57 per 1000 patient-years [5] and case-fatality rates 23%) [6,10] suggest a VTE-induced annual mortality of over 100,000 in the US population. Current treatment for VTE is primary anticoagulation, but hemostasis is impaired and many patients present with DVT that has primary anticoagulation, but hemostasis is impaired and many patients present with DVT that has already progressed past the point of anticoagulant efficacy [12,13].…”

“…This disease encompasses both deep vein thrombosis (DVT) and its potential sequelae, including pulmonary embolism (PE) if the thrombus is dislodged from the vein wall and post thrombotic syndrome (PTS) whereby the thrombus and its resolution damage the vein wall and causes venous hypertension [1]. Across recent studies (with follow-up periods ending 2009-2013) of American and European populations, the age-and sex-adjusted incidence of VTE has been reported to be 1.22-2.39 per 1000 patient-years, rising to 5-11 per 1000 patient-years by the eighth decade of life [2][3][4][5][6][7]. Of these VTE patients, 27-56% present with PE, putting them at imminent risk of death, while roughly another 20-50% of VTE patients later develop PTS, which reduces quality of life through loss in mobility, leg swelling, and skin ulcers [8].…”