The Burden of VTE
Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major public health problem.1–3
Despite an incidence that exceeds 1 per 1,0004 and data suggesting that VTE is the third most prevalent cardiovascular disease,4,5 the true burden posed by VTE is typically underestimated. There has been a tendency to both under-recognize the condition and underestimate its clinical and health-economic impact.
The silent threat of VTE
Under-recognition of the disease is caused in part by the fact that most VTEs are silent or asymptomatic. Indeed, the first manifestation of VTE can be fatal. Approximately 10% of hospital deaths are attributed to PE, but in 70–80% of these cases a diagnosis of PE was not even considered prior to death.2 Yet most hospitalized patients have one or more of the known and well-defined risk factors for VTE, and these risk factors are cumulative.2,3
Long-term consequences of VTE
In addition to the acute risks and morbidity posed by DVT and PE events, there is growing awareness of the chronic burden associated with VTE disease.4–7 The post-thrombotic syndrome (PTS) is a chronic condition that develops in 20–50% of patients within 1 to 2 years of symptomatic DVT.6 PTS is characterized by chronic, persistent pain, swelling, and other signs in the affected limb.6 Besides PTS, it is also thought that around 5% of patients treated for PE develop the serious complication of pulmonary hypertension.7
Europe–in excess of 0.5 million VTE deaths per year
In Europe, the size of the problem posed by VTE has been highlighted by the recent findings of an epidemiological modelling study, VITAE (VTE Impact Assessment Group in Europe).8 The approximate number of symptomatic VTE events per annum within the six participant EU countries was over 466,000 cases of DVT, 296,000 cases of PE, and 370,000 VTE-related deaths (range based on probabilistic sensitivity analysis). Based on European data,9 it has been estimated that the annual burden of fatal and non-fatal symptomatic VTE in 25 European countries exceeds 1.5 million events, a figure that includes over 543,000 deaths, 434,000 cases of PE, and 684,000 cases of DVT. Around 60% of these VTEs were hospital-acquired. The total direct costs of all these VTE events are estimated at EUR 3.07 billion each year.
Missed opportunities for recognition and prevention
With over 0.5 million deaths attributable to VTE, each year this disease kills more than twice the number of Europeans than breast cancer, prostate cancer, HIV/AIDS, and road traffic accidents (RTAs) combined. Of particular note is the VITAE study finding that 93% of these VTE-associated deaths were due to sudden PE, or followed an undiagnosed or untreated VTE. This highlights two salient points: first, that proper diagnosis is difficult and usually inaccurate, hence undiagnosed and untreated VTE deaths are common; and second, that prevention is the only way to prevent most VTE deaths, as most often there is no time to institute treatment prior to death in fatal VTE cases.
The European data is consistent with global data on the VTE disease burden. This disease is associated with a high mortality and extensive, yet frequently underestimated, long-term morbidity and costs. The situation is worsened by an under-estimation of the risks for VTE, and by possible missed opportunities for VTE prevention.2–4
- Geerts WH, Heit JA, et al. Prevention of venous thromboembolism. Chest. 2001;119 Suppl 1:132-75S.
- Geerts WH, Pineo GF, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126 Suppl 3:338-400S.
- Nicolaides AN, Breddin HK, et al. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol. 2001;20:1-37.
- Amin A, Stemkowski S, et al. Thromboprophylaxis rates in US medical centers: success or failure? J Thromb Haemost. 2007;5:1610-6.
- Heit JA, O'Fallon WM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162:1245-8.
- Kahn SR, Ginsberg JS. The relationship between deep venous thrombosis and the postthrombotic syndrome. Arch Intern Med. 2004;164:17-26.
- Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I22-30.
- Cohen AT, et al. Venous thromboembolism in Europe. Thromb Haemost. 2007;98:756-64. Sep 10.
- Oger et al. Plasma 17beta estradiol is inversely correlated with circulating vascular cell adhesion molecule. Thromb Haemost. 2000;83:657-6.