1. Chapter Three Venous Disease Coalition Epidemiology of VTE Risks, Risk Factors VTE Toolkit

2. Thromboembolic Disorders VTE Toolkit Acute coronary syndrome, ischemic or cardioembolic stroke, venous thromboembolic disease, acute limb ischemia Acute vascular diseases are the commonest cause of death VTE (DVT, PE) 3 rd commonest vascular disease More deaths from PE than AIDS, breast cancer and motor vehicle crashes combined Risk of VTE increases with age

3. Thromboembolic Disorders VTE Toolkit Affects approximately 1/1,000 people annually DVT alone accounts for 300,000–600,000 hospitalizations each year in the USA PE causes nearly 200,000 deaths per year in the USA Major costs of diagnosis, treatment

4. Who Is This? VTE Toolkit

5. Dan Blocker (Hoss Cartright) VTE Toolkit Of the hit TV show, Bonanza Died of pulmonary embolism after gall bladder surgery Age 43

6. Who Is This? VTE Toolkit

7. General George S. Patton VTE Toolkit One of the greatest generals of all time – “Old Blood and Guts” WWII commander of the US 3 rd army in Europe and North Africa December 1945 – car accident near Heidelberg Died of pulmonary embolism 12 days later Age 60 “May God have mercy on my enemies, because I won’t.”

8. Which of these politicians have had blood clots? VTE Toolkit

9. All of them had a blood clot! VTE Toolkit Dick Cheney Vice President 2001-2009 Jesse Ventura Gov. of Minnesota 1999-2003 Richard Nixon President 1969-1974 Dan Quayle Vice President 1989-1993 Hillary Clinton Secretary of State 2009-present

10. Who is at risk for VTE? VTE Toolkit

11. Risk Factors Surgery Trauma (major trauma or leg injury) Immobilization (bedrest, stroke, paralysis) Cancer and its treatment (CTX, RTX, hormonal) Acute medical illness (heart or respiratory failure, infection, inflammation) Previous DVT or PE Increased age Estrogen use (BCP, HRT), pregnancy, postpartum Central venous lines Blood clotting disorders (thrombophilia) VTE Toolkit

12. VTE Risk Increases with Age VTE Toolkit Residents of Worcester, MA Anderson - Arch Intern Med 1991;151:933

13. Population Attributable Risk for VTE VTE Toolkit (case-control study/adjusted for age, sex, year) Risk factor Adjusted AR Hospitalization with surgery 24% Hospitalization without surgery22% Active cancer 18% Nursing home 13% Trauma12% Prior CVC or pacemaker 9% Neurologic disease with leg paresis 7% Heit - Arch Intern Med 2002;162:1245

14. California Patient Discharge Database (N = 1,653,275) VTE during surgical admission or within 3 months Thromboprophylaxis data was not available Symptomatic VTE after Surgery VTE Toolkit Benign disease Hip replacement2.4% Craniotomy2.3% Knee replacement1.7% Coronary bypass1.1% Colectomy1.1% Hysterectomy0.3% TUR prostate0.3% Lap. Cholecystectomy0.2% Malignant disease Craniotomy3.6% Colectomy1.7% Pneumonectomy1.6% Rad. Prostatectomy1.5% Hysterectomy1.2% Mastectomy0.4% White - Thromb Haemost 2003;90:446

15. Postoperative VTE is Associated With Increased Mortality VTE Toolkit 118,258 surgical patients in 120 VA hospitals Symptomatic VTE is associated with significantly increased 30-day mortality Gangireddy - J Vasc Surg 2007;45:335 30-day VTEMortality No4.4% Yes16.9% p<0.0001

16. VTE is often a chronic disease Recurrent VTE is Common VTE Toolkit Cumulative Frequency of Recurrent VTE 30 % 25 % 20 % 15 % 10 % 5 % 0 1 2 3 4 5 6 7 8 Years Since Index DVT Prandoni - Ann Intern Med 1996;125:1

17. Post-Thrombotic Syndrome is Common VTE Toolkit  Prospective study of 355 patients with DVT  All patients advised to wear 40 mmHg stockings Pradoni – Ann Intern Med 1996; 125:1

18. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit