Chapter 36 - The epidemiology of venous thromboembolism in the community: Implications for prevention and management

Abstract

This chapter describes the incidence, survival, recurrence, complications, and risk factors for deep vein thrombosis of the leg, pelvis, or arm, and its complication, pulmonary embolism. The major complications of venous thromboembolism are venous stasis syndrome (e.g., postthrombotic syndrome, including dependent leg swelling and pain, stasis pigmentation and dermatitis, and dermatoliposclerosis), venous ulcer, and chronic thromboembolic pulmonary hypertension. To improve survival, avoid recurrence, prevent complications, and reduce health care costs, the occurrence of venous thromboembolism must be reduced. To reduce venous thromboembolism incidence, persons at risk of venous thromboembolism must first be identified. Independent risk factors for venous thromboembolism include patient age, surgery, trauma, hospital or nursing home confinement, active malignant neoplasm with or without concurrent chemotherapy, central vein catheterization or transvenous pacemaker, prior superficial vein thrombosis, varicose veins among the young, and neurological disease with extremity paresis; patients with chronic liver disease have a reduced risk. Recent family based studies indicate that venous thromboembolism is highly heritable and follows a complex mode of inheritance involving environmental interaction. Inherited reductions in plasma natural anticoagulants (e.g., antithrombin, protein C, or protein S) have long been recognized as uncommon, but potent risk factors for venous thromboembolism. Although the clinical utility of diagnostic testing for an inherited or acquired thrombophilia remains controversial, research studies hold the potential for further stratifying individual patients in to high- and low-risk for incident and recurrent venous thromboembolism, targeting prophylaxis to those who would benefit most, and, ultimately, reducing the occurrence of venous thromboembolism.