Epidemiology and prevention of venous thromboembolism

Abstract

In this Review, Lutsey and Zakai describe the epidemiology of venous thromboembolism, including incidence, risk factors and outcomes; summarize opportunities for primordial, primary and secondary prevention; and highlight the importance of reducing disparities in venous thromboembolism incidence and management, and opportunities to reduce them. Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them. Venous thromboembolism (VTE) surveillance systems are lacking, but VTE is estimated to affect one to two individuals per 1,000 person-years in Europe and the USA, with lower rates in other regions. Risk factors for VTE are varied, and include triggers (acute and subacute), basal risk factors (demographic, behavioural, anthropometric and genetic) and acquired clinical risk factors. Numerous complications can occur after a VTE event, and quality of life can decrease. Reduction in the risk of VTE and adverse outcomes after a VTE event will require prevention across the spectrum of prevention stages (primordial, primary and secondary) and increased awareness of this under-appreciated condition. Disparities exist in VTE incidence and outcomes; reducing these disparities will require individual, systems-based and societal commitments to equity.