The scope of the VTE problem is obviously enormous. The average annual incidence is about 100 per 100,000 person-years (Figure 4),[2]which equates to about 900,000 incident or recurring events per year in the United States and about 762,000 per year in the European Union. There are an estimated 296,000 deaths per year attributable to pulmonary embolism (PE), which is the third leading cause of cardiovascular death after myocardial infarction and stroke (a fact that is often forgotten).
- The incidence rates increase exponentially with age, which is a real conundrum in clinical medicine, because the major bleeding rates from anticoagulant therapy also increase with age.
- For recurrence rates it is important to appreciate that about 30% of patients will develop a recurrent VTE event within 5 years, which emphasizes the need to consider longer-term therapy for these patients, especially those with an unprovoked DVT.
Finally, post-thrombotic syndrome has been found in about 30% of patients with a proximal DVT. This can manifest in patients with venous stasis, swollen extremities, and venous ulcers, and importantly, 4% of patients with a PE will develop chronic pulmonary hypertension. Hylek E. Am J Med 2013; published on-line at http://education.amjmed.com/00000.
