Thrombosis Facts

Venous Thromboembolism (VTE)

  • VTE is the third most common type of cardiovascular disease.143
  • VTE causes over 500,000 deaths in Europe every year.12
  • An estimated 300,000 VTE-related deaths occur in the US each year.144
  • About one in eight patients will die as a result of a venous blood clot that develops while in the hospital.3, 40
  • The number of in-hospital deaths due to VTE is five times the total number of deaths from all hospital-acquired infections.145
  • The risk of symptomatic VTE after major orthopaedic surgery is higher than in the general population for at least two months after surgery.3
  • The estimated total number of symptomatic VTE events in the European Union (EU) is in excess of one million each year.12
  • Deaths attributable to VTE are estimated to exceed the total combined number of deaths from breast cancer, prostate cancer, AIDS, and traffic accidents annually.21
  • VTE is often clinically silent, and the first potentially fatal manifestation often occurs after discharge from the hospital.146
  • The incidence of first-time VTE increases exponentially with age: a) Under 15 years of age: <5 cases per 100, 000 per year; b) Over 80 years of age: 450-600 cases per 100,000 per year (~0.5%/year)40, 147
  • The probability of death after VTE is strongly associated with cancer, increased age, and the presence of cardiovascular disease.65
  • Hospitalised patients and residents of nursing homes account for about 60% of all cases of VTE.11
  • 20%-50% of patients who develop an idiopathic DVT will go on to develop post-thrombotic syndrome (PTS).74

Pulmonary Embolism (PE)

  • About 1 in 10 deaths that occur in the hospital is caused by pulmonary emboli.3
  • In the UK, PE kills more people than breast cancer, AIDS, and traffic accidents combined.3
  • About 10% of symptomatic PE results in death within one hour of the onset of symptoms.73
  • One-third of people with symptomatic venous blood clots have PE.65
  • PE can recur after the first event, and if it does, it is frequently fatal.148
  • The vast majority of the hospital deaths resulting from PE are preventable.149

Coronary Artery Disease (CAD) - Acute Coronary Syndrome (ACS)

  • Heart attack, a leading cause of death in the developed world, is most often triggered by acute thrombus formation within a coronary artery.95
  • Coronary artery disease is the single most common cause of death in Europe, accounting for nearly two million deaths per year.36
  • The risk of cardiovascular death, recurrent myocardial infarction (MI), or progression to MI in patients initially presenting with unstable angina is greatest during the first two months after the acute event.83

Atrial Fibrillation (AF)

  • An estimated 2.2 million people in the US and 4.5 million in the EU have atrial fibrillation.22
  • Cardioembolic stroke is one of the main complications of atrial fibrillation.4
  • The risk for stroke (for patients with AF) is age-dependent. In the Framingham study, the annual risk was 1.5% in those 50 to 59 years old and 23.5% in those 80 to 89 years old.150
  • Atrial fibrillation is the most common arrhythmia seen in clinical practice.4
  • For men 55 years of age, the lifetime risk for developing atrial fibrillation is 25%: for women 55 years old, the risk is 22%.4
  • Patients with no history of heart or lung disease make up less than 10 % of patients with atrial fibrillation.151
  • One in every six strokes occurs in a patient with atrial fibrillation.125
  • The prevalence of atrial fibrillation increases from less than 1% in those younger than 55 to 9% in persons 80 and older.79
  • 143 - Goldhaber SZ. Preventing pulmonary embolism and deep vein thrombosis: a call to action for vascular medicine specialists. Thromb Haemost 2007; 5(8): 1607–1609
  • 12 - Cohen AT, Agnelli G, Anderson FA, et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98(4):756-764.
  • 144 - Heit JA, Cohen AT, Anderson FAJ, on behalf of the VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. ASH Annual Meeting Abstracts. 106:910. 2005.
  • 3 - Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 suppl):338S-400S.
  • 40 - Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151(5):933-938.
  • 145 - House of Commons Health Committee. The prevention of venous thromboembolism in hospitalised patients. Available from http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/99.pdf
  • 21 - Fitzmaurice DA, Murray E. Thromboprophylaxis for adults in hospital. BMJ. 2007;334(7602):1017-1018.
  • 146 - Ferri F. Ferri's Clinical Advisor. 2004: Instant diagnosis and treatment. 6th ed. St Louis: Mosby, 2003.
  • 147 - Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158: 585–93.
  • 65 - White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 suppl 1):I4-I8.
  • 11 - Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost. 2005;3(8):1611-1617.
  • 74 - Kahn SR. The post-thrombotic syndrome: the forgotten morbidity of deep venous thrombosis. J Thromb Thrombolysis. 2006;21(1):41-48.
  • 73 - Kearon C. Natural history of venous thromboembolism. Circulation. 2003;107(23 suppl 1):I22-I30.
  • 148 - Kearon C. Natural history of venous thromboembolism. Semin Vasc Med. 2001;1: 27-37.
  • 149 - Sandler DA. Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med. 1989;89: 203-5.
  • 95 - Mackman N. Triggers, targets and treatments for thrombosis. Nature. 2008;451(7181):914-918.
  • 36 - British Heart Foundation. European Cardiovascular Disease Statistics, 2008. Available at http://www.heartstats.org/datapage.asp?id=7683. Accessed March 8, 2008.
  • 83 - Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116(7):e148-e304.
  • 22 - Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257-e354.
  • 4 - Lip GY, Tse HF. Management of atrial fibrillation. Lancet. 2007;370(9587):604-618.
  • 150 - Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983– 988.
  • 151 - Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol. 1994;74:236-241.
  • 125 - Hart RG, Halperin JL. Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Int Med.1999;131(9):688-695.
  • 79 - Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285(18):2370-2375.
Acute coronary syndrome
This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.
Angina
Heart condition characterised by intermittent chest pain. Angina usually results from coronary artery disease and may further be classified as stable or unstable angina. Stable angina refers to the more common understanding of angina related to myocardial ischemia. Unstable angina may occur unpredictably at rest which may be a serious indicator of an impending heart attack.
Arrhythmia
Any variation from the normal rhythm of the heart beat (e.g., sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia).
Myocardial infarction
Destruction of heart tissue due to reduced blood flow to the heart. Also known as a heart attack. It usually results from coronary artery disease and is more severe than angina.
Post-thrombotic syndrome
A syndrome that can follow a vascular thrombosis. Clinical signs and symptoms of this syndrome include chronic pain, swelling, oedema, discolouration, and in severe cases, venous ulceration. It is likely that valvular incompetence is associated with the clinical manifestations of post-thrombotic syndrome.
Venous thromboembolism
A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE. The term encompasses both DVT and PE.