Thromb Haemost 2009; 101(06): 1095-1099
DOI: 10.1160/TH08-11-0755
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Trends in prevalence of deep venous thrombosis among hospitalised patients in an Asian institution

Heng Joo Ng
1   Department of Haematology, Singapore General Hospital, Singapore
Lai Heng Lee
1   Department of Haematology, Singapore General Hospital, Singapore
› Author Affiliations
Financial support: This study was supported by the Singhealth Cluster Research Fund.
Further Information

Publication History

Received: 17 November 2008

Accepted after major revision: 06 February 2009

Publication Date:
24 November 2017 (online)


Venous thromboembolism (VTE) has long been considered a disease of secondary importance among Asians because of its perceived low prevalence. We studied the prevalence and patterns of deep venous thrombosis (DVT) among hospitalised patients in our tertiary referral centre. Primary and secondary DVT prevalence among hospitalised patients was 0.453%, a significant rise from reported rates of 0.079% and 0.158% in 1989–1990 and 1996–1997, respectively. Malignancies and orthopaedic surgery were the most common risk factors for DVT. Further comparisons with the two earlier Singaporean studies showed no changes in the gender and ethnic background of patients but a higher proportion of elderly patients (>80 years) was recorded in the current study (11.7% vs. 7.0%, p = 0.04). Statistically significant increases were found in all medical and surgical disciplines except among obstetrics and gynaecology patients. Orthopaedic patients had the highest increase in DVT rates between the 1989–1990 and 2002–2003 periods (0.082% vs. 0.96%, p<0.01). Doppler ultrasound scans performed increased from approximately one per 100 admissions in 1996–1997 to one per 30 admissions in 2002–2003. The significant increase in period prevalence of DVT among hospitalised patients in Singapore could be accounted by methodologic differences between comparative studies, an increase in proportion of elderly patients and most importantly, a possible shift in perception of the importance of VTE among Asians, resulting in a higher index of suspicion and lower threshold for performing diagnostic tests.

  • References

  • 1 Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost 2005; 3: 1611-1617.
  • 2 Tinckler LF. Absence of pulmonary embolism in Asians?. Br Med J 1964; 1: 502.
  • 3 Hwang WS. The rarity of pulmonary thromboembolism in asians. Singapore Med J 1968; 9: 276-279.
  • 4 Mitra AK, Khoo TK, Ngan CC. Deep-vein thrombosis following hip surgery for fracture of the proximal femur. Singapore Med J 1989; 30: 530-534.
  • 5 Kishimoto M, Lim HY, Tokuda Y. et al. Prevalence of venous thromboembolism at a teaching hospital in Okinawa, Japan. Thromb Haemost 2005; 93: 876-879.
  • 6 Lee LH, Gu KQ, Heng D. Deep vein thrombosis is not rare in Asia--the Singapore General Hospital experience. Ann Acad Med Singapore 2002; 31: 761-764.
  • 7 Leizorovicz A, Turpie AG, Cohen AT. et al. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost 2005; 3: 28-34.
  • 8 Leung V, Leung V, Lui W. et al. Incidence of deep vein thrombosis in hospitalized Chinese medical patients is similar to that in western populations. Thromb Res 2006; 118: 763-764.
  • 9 Piovella F, Wang CJ, Lu H. et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost 2005; 3: 2664-2670.
  • 10 De Silva DA, Pey HB, Wong MC. et al. Deep vein thrombosis following ischemic stroke among Asians. Cerebrovasc Dis 2006; 22: 245-250.
  • 11 Kueh YK, Wang TL, Teo CP. et al. Acute deep vein thrombosis in hospital practice. Ann Acad Med Singapore 1992; 21: 345-348.
  • 12 Singapore Department of Statistics. Singapore in Figures. 2008 ed; 2008.
  • 13 Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 2000; 85: 1334-1337.
  • 14 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: 737-740.
  • 15 Hooper WC, Holman RC, Heit JA. et al. Venous thromboembolism hospitalizations among American Indians and Alaska Natives. Thromb Res 2002; 108: 273-278.
  • 16 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: 19-25.
  • 17 Silverstein MD, Heit JA, Mohr DN. et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.
  • 18 Rees DC, Cox M, Clegg JB. World distribution of factor V Leiden. Lancet 1995; 346: 1133-1134.
  • 19 Rosendaal FR, Doggen CJ, Zivelin A. et al. Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 1998; 79: 706-708.
  • 20 Angchaisuksiri P, Pingsuthiwong S, Aryuchai K. et al. Prevalence of the G1691A mutation in the factor V gene (factor V Leiden) and the G20210A prothrombin gene mutation in the Thai population. Am J Hematol 2000; 65: 119-122.
  • 21 Jun ZJ, Ping T, Lei Y. et al. Prevalence of factor V Leiden and prothrombin G20210A mutations in Chinese patients with deep venous thrombosis and pulmonary embolism. Clin Lab Haematol 2006; 28: 111-116.
  • 22 Lim LC, Tan HH, Lee LH. et al. Activated protein C resistance: a study among 60 thromboembolic patients in the Singapore population. Ann Acad Med Singapore 1999; 28: 252-255.
  • 23 Seow A, Koh WP, Chia KS. et al. Trends in Cancer Incidence in Singapore 1968–2002. Singapore Cancer Registry Report No.6. 6 ed. 2004.
  • 24 Goodacre S, Sampson F, Thomas S. et al. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging 2005; 5: 6.
  • 25 Kearon C, Julian JA, Newman TE. et al. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med 1998; 128: 663-677.