Abstract
Venous thromboembolism (VTE) is an important cause of morbidity and mortality in Western countries. The incidence rate of VTE is estimated at 1–2 cases per 1000 annually. This study was a population-based cohort study of previously treatment naïve patients with a first occurrence of venous thromboembolism (VTE), using data from the administrative health data register of the Stockholm Region 2011–2018. Data on anticoagulant treatment was taken from the Swedish Prescribed Drug Register. We also analyzed all VTE events between 2011 and 2018. Altogether 14,849 naïve incident VTE cases were identified. In 2011 the majority of patients with a first episode of VTE were prescribed warfarin versus non-vitamin K antagonist oral anticoagulants (NOACs), 1144 versus 5. In contrast in 2018, the majority of patients were treated with NOACs, 1049 versus 59 treated with warfarin. Treatment with low molecular weight heparin only decreased from 814 to 683 patients. The frequency of all VTE events in the population increased over time from 1.88/1000 to 1.93/1000 (p = 0.072), and PE diagnoses increased from 0.69/1000 to 0.76/1000 (p = 0.003). In conclusion, during 2011–2018 there has been a shift of prescription of warfarin to a clear predominance of NOACs in the treatment of VTE in the Stockholm Region, in line with current recommendations. In the clinical situation, treatment has been simplified as monitoring of warfarin has decreased substantially. PE events increased during the time period in the population even if the increase was rather modest, while all VTE events did not increase significantly.
Highlights
Venous thromboembolism (VTE) is an important cause of morbidity and mortality in Western countries, with an incidence rate of 1–2 cases per 1000 and year [1,2,3,4,5,6,7]
Few cases of VTE were diagnosed in children
Data regarding comorbidities showed high proportions; i.e. 68.0% of the patients suffered from hypertension, 24.8% of the patients had cancer, 20.2% diabetes mellitus, 18.7% stroke, 17.5% heart failure, and 16.8% had atrial fibrillation
Summary
Venous thromboembolism (VTE) is an important cause of morbidity and mortality in Western countries, with an incidence rate of 1–2 cases per 1000 and year [1,2,3,4,5,6,7]. In Sweden, the incidence of deep venous thrombosis (DVT) is estimated at 1.67 per 1000 per year, with pulmonary embolism (PE) 0.8 per 1000 per year [8]. Both acquired and genetic risk factors contribute to the risk of VTE [9, 10]. Important acquired risk factors for VTE include [9,10,11]: age, major surgery, trauma, immobilization, malignancy, prior VTE, presence of central venous lines, chronic heart failure, estrogen therapy, pregnancy and the post-partum period. A recently published large study with 1.1 million participants from 76 different cohorts, found that older age, smoking, and adiposity were consistently associated with higher VTE risk [12]
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