Semin Thromb Hemost 2014; 40(07): 724-735
DOI: 10.1055/s-0034-1390325
In Focus Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thrombosis: A Major Contributor to Global Disease Burden[*]

Gary E. Raskob
1   College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Pantep Angchaisuksiri
2   Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Alicia N. Blanco
3   Division of Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina
Harry Büller
4   Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
Alexander Gallus
5   Department of Hematology, SA Pathology, Flinders Medical Center, Adelaide, South Australia, Australia
Beverley J. Hunt
6   Thrombosis and Thrombophilia Centre, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
Elaine M. Hylek
7   Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
The Lord Kakkar
8   Thrombosis Research Institute, London, United Kingdom
Stavros V. Konstantinides
9   Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University, Mainz, Germany
Micah McCumber
1   College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Yukio Ozaki
10   Department of Laboratory Medicine, University of Yamanashi, Yamanashi, Japan
Aaron Wendelboe
1   College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Jeffrey I. Weitz
11   Thrombosis and Atherosclerosis Research Institute, and McMaster University, Hamilton, Ontario, Canada
; ISTH Steering Committee for World Thrombosis Day › Author Affiliations
Further Information

Publication History

Publication Date:
10 October 2014 (online)


Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden due to VTE in low-, middle-, and high-income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1,000 individuals in the population. The incidence increased to between 2 and 7 per 1,000 among those 70 years of age or more. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted-life-years (DALYs) lost in low- and middle-income countries, and second in high-income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low-, middle-, and high-income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilization of preventive measures will reduce the burden.

* Reprinted with permission from: ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. J Thromb Haemost 2014;12:1580–1590; DOI: 10.1111/jth.12698. ©2014 International Society on Thrombosis and Haemostasis.

  • References

  • 1 Hunter DJ, Fineberg HV. Convergence to common purpose in global health. N Engl J Med 2014; 370 (18) 1753-1755
  • 2 Jamison DT, Summers LH, Alleyne G , et al. Global health 2035: a world converging within a generation. Lancet 2013; 382 (9908) 1898-1955
  • 3 Lozano R, Naghavi M, Foreman K , et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859) 2095-2128
  • 4 Horton R. GBD 2010: understanding disease, injury, and risk. Lancet 2012; 380 (9859) 2053-2054
  • 5 Murray CJ, Ezzati M, Flaxman AD , et al. GBD 2010: design, definitions, and metrics. Lancet 2012; 380 (9859) 2063-2066
  • 6 Murray CJ, Vos T, Lozano R , et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859) 2197-2223
  • 7 Feigin VL, Forouzanfar MH, Krishnamurthi R , et al; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383 (9913) 245-254
  • 8 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
  • 9 Yusuf HR, Tsai J, Atrash HK, Boulet S, Grosse SD. Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations—United States, 2007-2009. MMWR Morb Mortal Wkly Rep 2012; 61 (22) 401-404
  • 10 Kahn S, Lim W, Dunn AS , et al; American College of Chest Physicians. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl) e195S-226S
  • 11 Gould MK, Garcia DA, Wren SM , et al; American College of Chest Physicians. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl) e227S-277S
  • 12 Falck-Yitter Y, Francis CW, Johanson NA , et al; American College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl) e278S-325S
  • 13 Nicolaides AN, Fareed J, Kakkar AK , et al. Prevention and treatment of venous thromboembolism—International Consensus Statement. Int Angiol 2013; 32 (2) 111-260
  • 14 Hald EM, Enga KF, Løchen ML , et al. Venous thromboembolism increases the risk of atrial fibrillation: the Tromso study. J Am Heart Assoc 2014; 3 (1) e000483
  • 15 Holst AG, Jensen G, Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation 2010; 121 (17) 1896-1903
  • 16 Moretti AM, Tafuri S, Parisi D, Germinario C. Epidemiology of pulmonary embolism in Apulia from analysis of current data. Monaldi Arch Chest Dis 2010; 73 (1) 18-24
  • 17 Severinsen MT, Johnsen SP, Tjønneland A, Overvad K, Dethlefsen C, Kristensen SR. Body height and sex-related differences in incidence of venous thromboembolism: a Danish follow-up study. Eur J Intern Med 2010; 21 (4) 268-272
  • 18 Huerta C, Johansson S, Wallander MA, García Rodríguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med 2007; 167 (9) 935-943
  • 19 Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrøm J. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5 (4) 692-699
  • 20 Guijarro R, San Román CM, Perelló JI, Nuño E. Efficiency Group of the Internal Medicine Services of Andalusia; Strategic Plan of the SADEMI (Andalusia Society of Internal Medicine). A study of hospital discharges for venous thromboembolism in the south of Spain. An analysis of 19,170 cases from a regional database from 1998 to 2001. Eur J Intern Med 2005; 16 (4) 279-286
  • 21 Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000; 83 (5) 657-660
  • 22 Nordström M, Lindblad B, Bergqvist D, Kjellström T. A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 1992; 232 (2) 155-160
  • 23 Kierkegaard A. Incidence of acute deep vein thrombosis in two districts. A phlebographic study. Acta Chir Scand 1980; 146 (4) 267-269
  • 24 Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 2013; 126 (9) e13-e21
  • 25 Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011; 171 (9) 831-837
  • 26 Cushman M, Tsai AW, White RH , et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117 (1) 19-25
  • 27 Stein PD, Kayali F, Olson RE, Milford CE. Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. Am J Med 2004; 116 (7) 435-442
  • 28 Janke RM, McGovern PG, Folsom AR. Mortality, hospital discharges, and case fatality for pulmonary embolism in the Twin Cities: 1980-1995. J Clin Epidemiol 2000; 53 (1) 103-109
  • 29 Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 2000; 85 (11) 1334-1337
  • 30 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (6) 585-593
  • 31 White RH, Zhou H, Romano PS. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Intern Med 1998; 128 (9) 737-740
  • 32 Anderson Jr. FA, 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
  • 33 Shiraev TP, Omari A, Rushworth RL. Trends in pulmonary embolism morbidity and mortality in Australia. Thromb Res 2013; 132 (1) 19-25
  • 34 Ho WK, Hankey GJ, Eikelboom JW. The incidence of venous thromboembolism: a prospective, community-based study in Perth, Western Australia. Med J Aust 2008; 189 (3) 144-147
  • 35 Vázquez FJ, Posadas-Martínez ML, Vicens J, González Bernaldo de Quirós F, Giunta DH. Incidence rate of symptomatic venous thromboembolic disease in patients from a medical care program in Buenos Aires, Argentina: a prospective cohort. Thromb J 2013; 11 (1) 16
  • 36 Jang MJ, Bang SM, Oh D. Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 2011; 9 (1) 85-91
  • 37 Lee CH, Lin LJ, Cheng CL, Kao Yang YH, Chen JY, Tsai LM. Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population. J Thromb Haemost 2010; 8 (7) 1515-1523
  • 38 Cheuk BL, Cheung GC, Cheng SW. Epidemiology of venous thromboembolism in a Chinese population. Br J Surg 2004; 91 (4) 424-428
  • 39 Woo KS, Tse LK, Tse CY, Metreweli C, Vallance-Owen J. The prevalence and pattern of pulmonary thromboembolism in the Chinese in Hong Kong. Int J Cardiol 1988; 20 (3) 373-380
  • 40 Kröger K, Moerchel Ch, Moysidis T, Santosa F. Incidence rate of pulmonary embolism in Germany: data from the federal statistical office. J Thromb Thrombolysis 2010; 29 (3) 349-353
  • 41 Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol 2011; 86 (2) 217-220
  • 42 Deitelzweig SB, Lin J, Johnson BH, Schulman KL. Venous thromboembolism in the US: does race matter?. J Thromb Thrombolysis 2011; 31 (2) 133-138
  • 43 Abdul Sultan A, Tata LJ, Grainge MJ, West J. The incidence of first venous thromboembolism in and around pregnancy using linked primary and secondary care data: a population based cohort study from England and comparative meta-analysis. PLoS ONE 2013; 8 (7) e70310
  • 44 Kane EV, Calderwood C, Dobbie R, Morris C, Roman E, Greer IA. A population-based study of venous thrombosis in pregnancy in Scotland 1980-2005. Eur J Obstet Gynecol Reprod Biol 2013; 169 (2) 223-229
  • 45 Heyl PS, Sappenfield WM, Burch D, Hernandez LE, Kavanaugh VM, Hill WC. Pregnancy-related deaths due to pulmonary embolism: findings from two state-based mortality reviews. Matern Child Health J 2013; 17 (7) 1230-1235
  • 46 Virkus RA, Løkkegaard EC, Bergholt T, Mogensen U, Langhoff-Roos J, Lidegaard Ø. Venous thromboembolism in pregnant and puerperal women in Denmark 1995-2005. A national cohort study. Thromb Haemost 2011; 106 (2) 304-309
  • 47 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (6) 1302-1309
  • 48 Sharma S, Monga D. Venous thromboembolism during pregnancy and the post-partum period: incidence and risk factors in a large Victorian health service. Aust N Z J Obstet Gynaecol 2008; 48 (1) 44-49
  • 49 Samuelsson E, Hellgren M, Högberg U. Pregnancy-related deaths due to pulmonary embolism in Sweden. Acta Obstet Gynecol Scand 2007; 86 (4) 435-443
  • 50 Wen SW, Huang L, Liston R , et al; Maternal Health Study Group, Canadian Perinatal Surveillance System. Severe maternal morbidity in Canada, 1991-2001. CMAJ 2005; 173 (7) 759-764
  • 51 Fawcus SR, van Coeverden de Groot HA, Isaacs S. A 50-year audit of maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953-2002). BJOG 2005; 112 (9) 1257-1263
  • 52 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143 (10) 697-706
  • 53 Sullivan EA, Ford JB, Chambers G, Slaytor EK. Maternal mortality in Australia, 1973-1996. Aust N Z J Obstet Gynaecol 2004; 44 (5) 452-457 , discussion 377
  • 54 Lindqvist P, Dahlbäck B, Marŝál K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999; 94 (4) 595-599
  • 55 Santosa F, Moysidis T, Moerchel C, Kröger K, Bufe A. Pulmonary embolism in young people. Trends in Germany from 2005 to 2011. Hamostaseologie 2014; 34 (1) 88-92
  • 56 Reardon G, Pandya N, Nutescu EA , et al. Incidence of venous thromboembolism in nursing home residents. J Am Med Dir Assoc 2013; 14 (8) 578-584
  • 57 Schmidt M, Johannesdottir SA, Lemeshow S , et al. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open 2013; 3 (4) e002698
  • 58 Sweetland S, Beral V, Balkwill A , et al; Million Women Study Collaborators. Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study. J Thromb Haemost 2012; 10 (11) 2277-2286
  • 59 Moysidis T, Kröger K, Moerchel C, Santosa F, Gröchenig E. Pulmonary embolism in young males and females in Germany: data from the Federal Statistical Office. Blood Coagul Fibrinolysis 2010; 21 (6) 511-515
  • 60 Lutsey PL, Virnig BA, Durham SB , et al. Correlates and consequences of venous thromboembolism: The Iowa Women's Health Study. Am J Public Health 2010; 100 (8) 1506-1513
  • 61 Spannagl M, Heinemann LA, Dominh T, Assmann A, Schramm W, Schürmann R. Comparison of incidence/risk of venous thromboembolism (VTE) among selected clinical and hereditary risk markers: a community-based cohort study. Thromb J 2005; 3: 8
  • 62 Samuelsson E, Hägg S. Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users. Acta Obstet Gynecol Scand 2004; 83 (7) 674-681
  • 63 Mellemkjaer L, Sørensen HT, Dreyer L, Olsen J, Olsen JH. Admission for and mortality from primary venous thromboembolism in women of fertile age in Denmark, 1977-95. BMJ 1999; 319 (7213) 820-821
  • 64 Kniffin Jr WD, Baron JA, Barrett J, Birkmeyer JD, Anderson Jr FA. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154 (8) 861-866
  • 65 Gaborit FS, Overvad K, Nørgaard M, Kristensen SR, Tjønneland A, Severinsen MT. Alcohol intake and risk of venous thromboembolism. A Danish follow-up study. Thromb Haemost 2013; 110 (1) 39-45
  • 66 Kunisawa S, Ikai H, Imanaka Y. Incidence and prevention of postoperative venous thromboembolism: are they meaningful quality indicators in Japanese health care settings?. World J Surg 2012; 36 (2) 280-286 [ Erratum in World J Surg 2012;36:278−279]
  • 67 White RH, Dager WE, Zhou H, Murin S. Racial and gender differences in the incidence of recurrent venous thromboembolism. Thromb Haemost 2006; 96 (3) 267-273
  • 68 Beemath A, Skaf E, Stein PD. Pulmonary embolism as a cause of death in adults who died with heart failure. Am J Cardiol 2006; 98 (8) 1073-1075
  • 69 Petrauskiene V, Falk M, Waernbaum I, Norberg M, Eriksson JW. The risk of venous thromboembolism is markedly elevated in patients with diabetes. Diabetologia 2005; 48 (5) 1017-1021
  • 70 Gomes JP, Shaheen WH, Truong SV, Brown EF, Beasley BW, Gajewski BJ. Incidence of venous thromboembolic events among nursing home residents. J Gen Intern Med 2003; 18 (11) 934-936
  • 71 Stein PD, Matta F, Yaekoub AY. Incidence of vena cava thrombosis in the United States. Am J Cardiol 2008; 102 (7) 927-929
  • 72 Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf 2013; 22 (10) 809-815
  • 73 Access Economics Pty Limited. The Burden of Venous Thromboembolism in Australia. The Australia and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism; 2008
  • 74 Wilson RM, Michel P, Olsen S , et al; WHO Patient Safety EMRO/AFRO Working Group. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ 2012; 344: e832
  • 75 Aranaz-Andrés JM, Aibar-Remón C, Limón-Ramírez R , et al; IBEAS team. Prevalence of adverse events in the hospitals of five Latin American countries: results of the 'Iberoamerican Study of Adverse Events' (IBEAS). BMJ Qual Saf 2011; 20 (12) 1043-1051
  • 76 Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost 2010; 8 (10) 2105-2112
  • 77 Angchaisuksiri P. Venous thromboembolism in Asia—an unrecognised and under-treated problem?. Thromb Haemost 2011; 106 (4) 585-590
  • 78 Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008; 28 (3) 370-372
  • 79 Heit J, Cohen AT, Anderson FJ. Estimated annual number of incident and recurrent, fatal and non-fatal venous thromboembolism (VTE) events in the US. Blood 2005; 106: 267A
  • 80 Kahn SR, Hirsch A, Shrier I. Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis. Arch Intern Med 2002; 162 (10) 1144-1148
  • 81 Kachroo S, Boyd D, Bookhart BK , et al. Quality of life and economic costs associated with postthrombotic syndrome. Am J Health Syst Pharm 2012; 69 (7) 567-572
  • 82 Heit JA, Rooke TW, Silverstein MD , et al. Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study. J Vasc Surg 2001; 33 (5) 1022-1027
  • 83 Pengo V, Lensing AW, Prins MH , et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350 (22) 2257-2264
  • 84 Noble S, Lewis R, Whithers J, Lewis S, Bennett P. Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study. BMJ Open 2014; 4 (4) e004561
  • 85 Cohen AT, Spiro TE, Büller HR , et al; MAGELLAN Investigators. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 2013; 368: 513-523
  • 86 Goldhaber SZ, Leizorovicz A, Kakkar AK , et al; ADOPT Trial Investigators. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011; 365 (23) 2167-2177
  • 87 Raskob GE, Gallus AS, Pineo GF , et al. Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials. J Bone Joint Surg Br 2012; 94 (2) 257-264
  • 88 Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA 2014; 311 (7) 717-728
  • 89 Cohen AT, Tapson VF, Bergmann JF , et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610) 387-394 [ Erratum in Lancet 2008;371:1914]
  • 90 Lester W, Freemantle N, Begaj I, Ray D, Wood J, Pagano D. Fatal venous thromboembolism associated with hospital admission: a cohort study to assess the impact of a national risk assessment target. Heart 2013; 99 (23) 1734-1739
  • 91 Catterick D, Hunt BJ. Impact of the national venous thromboembolism risk assessment tool in secondary care in England: retrospective population-based database study. Blood Coagul Fibrinolysis 2014; 25 (6) 571-576
  • 92 Sixty-sixth World Health Assembly. Follow-up to the political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. Available at: ; Accessed May 27, 2013