Abstract
Background
The clinical epidemiology of venous thromboembolism has changed recently because of
advances in identification, prophylaxis, and treatment. We sought to describe secular
trends in the occurrence of venous thromboembolism among residents of the Worcester,
Massachusetts, metropolitan statistical area.
Methods
Population-based methods were used to monitor trends in event rates of first-time
or recurrent venous thromboembolism in 5025 Worcester, Massachusetts, metropolitan
statistical area residents who were diagnosed with acute pulmonary embolism or lower-extremity
deep vein thrombosis during 9 annual periods between 1985 and 2009. Medical records
were reviewed by abstractors and validated by clinicians.
Results
Age- and sex-adjusted annual event rates for first-time venous thromboembolism increased
from 73 (95% confidence interval [CI], 64-82) per 100,000 in 1985/1986 to 133 (CI,
122-143) in 2009, primarily because of an increase in pulmonary embolism. The rate
of recurrent venous thromboembolism decreased from 39 (CI, 32-45) in 1985/1986 to
19 (CI, 15-23) in 2003, and then increased to 35 (CI, 29-40) in 2009. There was an
increasing trend in using noninvasive diagnostic testing, with approximately half
of tests being invasive in 1985/1986 and almost all noninvasive by 2009.
Conclusions
Despite advances in identification, prophylaxis, and treatment between 1985 and 2009,
the annual event rate of venous thromboembolism has increased and remains high. Although
these increases partially may be due to increased sensitivity of diagnostic methods,
especially for pulmonary embolism, they also may imply that current prevention and
treatment strategies are less than optimal.
Keywords
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Article info
Publication history
Published online: May 06, 2014
Footnotes
Funding: The project described was supported by grants from the National Heart, Lung, and Blood Institute (R01-HL35862, R01-HL70283), and National Institute on Aging (R01AG031083). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institute of Aging.
Conflict of Interest: FAS has received research grants from Sanofi and The Medicines Company and has served as a consultant to GlaxoSmithKline and Millennium on the design of outcomes studies.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
