Advertisement

Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study

  • Frederick A. SpencerEmail author
  • Cathy Emery
  • Samuel W. Joffe
  • Luigi Pacifico
  • Darleen Lessard
  • George Reed
  • Joel M. Gore
  • Robert J. Goldberg
Article

Abstract

While there have been advances in prophylaxis and management of venous thromboembolism (VTE), there are a dearth of data from the perspective of a community-wide study, on the epidemiology, management, and outcomes of patients with a first episode of deep vein thrombosis (DVT) or pulmonary embolism (PE). The purpose of this population-based observational study was to describe trends in the incidence rates, clinical profile, management, and outcomes for patients with VTE. The medical records of Worcester (MA) metropolitan area residents with ICD-9 codes consistent with possible VTE during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors. A total of 1,567 persons with first-time VTE were identified. Incidence rates (per 100,000) of VTE were stable between 1999 (109) and 2003 (117). A considerable proportion of patients treated for VTE had events of unclear clinical significance (e.g., isolated calf DVT, unconfirmed “possible” PE). By 2003, low-molecular-weight heparin was increasingly utilized as acute therapy and more than 25% of patients with VTE were managed as outpatients. Cumulative rates of recurrent VTE and major bleeding following initial VTE were high (~16% and 12%, respectively, mean follow-up 1,216 days) and did not change significantly between 1999 and 2003. Our data suggest that while the incidence rates of VTE remain high, and outcomes suboptimal, there have been marked changes in its management. Whether these changes will result in future declines in VTE incidence and/or improved outcomes in the community setting will require further surveillance.

Keywords

Venous thromboembolism Deep vein thrombosis Pulmonary embolism Epidemiology 

Notes

Acknowledgment

This study was made possible by the cooperation of administrators, physicians, and medical records personnel in 12 central Massachusetts hospitals.

References

  1. 1.
    The leapfrog group hospital quality and safety survey. https://leapfrog.medstat.com
  2. 2.
    White paper (2003) Deep vein thrombosis. Advancing awareness to protect patient lives. Public health leadership conference on deep-vein thrombosis, American public health association. http://www.apha.org/NR/rdonlyres/A209F84A-7C0E-4761-9ECF-61D22E1E11F7/0/DVT_White_Paper.pdf
  3. 3.
    Anderson FA, Wheeler HB, Goldberg RJ et al (1991) 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 151:933–938CrossRefPubMedGoogle Scholar
  4. 4.
    Silverstein MD, Heit JA, Mohr DN et al (1998) Trends in the incidence of deep vein thrombosis and pulmonary embolism. A 25-year population-based study. Arch Intern Med 158:585–593CrossRefPubMedGoogle Scholar
  5. 5.
    Heit JA (2005) Venous thromboembolism: disease burdens, outcomes, and risk factors. J Haemost Thromb 3:1611–1617CrossRefGoogle Scholar
  6. 6.
    Spencer FA, Emery C, Lessard D et al (2006) The Worcester venous thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 21:722–727CrossRefPubMedGoogle Scholar
  7. 7.
    Spencer FA, Lessard D, Emery C et al (2007) Venous thromboembolism in the outpatient setting. Arch Intern Med 167:1471–1475CrossRefPubMedGoogle Scholar
  8. 8.
    Spencer FA, Gore JM, Lessard D et al (2008) Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester venous thromboembolism study. Arch Intern Med 168:425–430CrossRefPubMedGoogle Scholar
  9. 9.
    Oger E, EPI-GETBO Study Group (2000) Incidence of venous thromboembolism: a community-based study in Western France. Thromb Haemost 83:657–660PubMedGoogle Scholar
  10. 10.
    Buller HR, Agnelli G, Hull RD et al (2004) Antithrombotic therapy for venous thromboembolic disease: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:401–428CrossRefGoogle Scholar
  11. 11.
    Kearon C, Julian JA, Newman TE, Ginsberg JS (1998) Noninvasive diagnosis of deep venous thrombosis. McMaster diagnostic imaging practice guidelines initiative. Ann Intern Med 128:663–677PubMedGoogle Scholar
  12. 12.
    Kakkar VV, Howe CT, Flanc C, Clarke MB (1969) Natural history of postoperative deep-vein thrombosis. Lancet 2:230–232CrossRefPubMedGoogle Scholar
  13. 13.
    Righini M, Paris S, Le Gal G, Laroche JP, Perrier A, Bounameaux H (2006) Clinical relevance of distal deep vein thrombosis: review of literature data. Thromb Haemost 95:56–64PubMedGoogle Scholar
  14. 14.
    Kearon C (1998) Diagnosis of a first episode of deep vein thrombosis. In: Ginsberg JS, Kearon C, Hirsh J (eds) Critical decisions in thrombosis and hemostasis. B.C. Decker Inc, Hamilton, Ontario, pp 22–26Google Scholar
  15. 15.
    Hull RD, Raskob GE, Pineo GF et al (1992) Subcutaneous low-molecular-weight heparin compared with continuos intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med 326:975–983PubMedGoogle Scholar
  16. 16.
    Prandoni P, Lensing AW, Buller HR et al (1992) Comparison of subcutaneous low-molecular-weight heparin with intravenous standard heparin in proximal deep-vein thrombosis. Lancet 339:411–415CrossRefGoogle Scholar
  17. 17.
    Levine M, Gent M, Hirsh J et al (1996) A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 334:677–681CrossRefPubMedGoogle Scholar
  18. 18.
    Fiessinger JN, Huisman MV, Davidson BL et al (2005) THRIVE Treatment Study Investigators. Ximelagatran vs low-molecular-weight heparin and warfarin for the treatment of deep vein thrombosis. A randomized trial. JAMA 293:681–689CrossRefPubMedGoogle Scholar
  19. 19.
    Buller HR, Davidson BL, Decousus H et al (2004) Matisse Investigators. Fondaparinox or enoxaparin for the initial treatment of symptomatic deep vein thrombosis. A randomized trial. Ann Intern Med 140:867–873PubMedGoogle Scholar
  20. 20.
    Prandoni P, Lensing AW, Cogo A et al (1996) The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 125:1–7PubMedGoogle Scholar
  21. 21.
    Kearon C, Ginsberg JS, Kovacs MJ et al (2003) Comparison of low-intensity warfarin therapy with conventional intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 349:631–639CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Frederick A. Spencer
    • 1
    • 2
    Email author
  • Cathy Emery
    • 2
  • Samuel W. Joffe
    • 2
  • Luigi Pacifico
    • 3
  • Darleen Lessard
    • 2
  • George Reed
    • 2
  • Joel M. Gore
    • 2
  • Robert J. Goldberg
    • 2
  1. 1.Department of MedicineMcMaster University—Faculty of Health SciencesHamiltonCanada
  2. 2.University of Massachusetts Medical SchoolWorcesterUSA
  3. 3.Department of ResearchFallon ClinicWorcesterUSA

Personalised recommendations