Thromb Haemost 2017; 117(02): 390-400
DOI: 10.1160/TH16-07-0509
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Reasons for the persistent incidence of venous thromboembolism

John A. Heit
1  Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
2  Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
4  Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
,
Aneel A. Ashrani
2  Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
,
Daniel J. Crusan
3  Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
,
Robert D. McBane
1  Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
,
Tanya M. Petterson
3  Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
,
Kent R. Bailey
3  Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
› Author Affiliations
Financial support: Research reported in this publication was supported by grants from the National Heart, Lung and Blood Institute under Award Number R01HL066216 to JAH, and the National Institute on Aging under Award Number R01AG034676, of the National Institutes of Health, and by Mayo Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Further Information

Publication History

Received:05 July 2016

Accepted after major revision:28 October 2016

Publication Date:
01 December 2017 (online)

Summary

Reasons for trends in venous thromboembolism (VTE) incidence are uncertain. It was our objective to determine VTE incidence trends and risk factor prevalence, and estimate population-attributable risk (PAR) trends for each risk factor. In a population-based cohort study of all residents of Olmsted County, Minnesota from 1981–2010, annual incidence rates were calculated using incident VTE cases as the numerator and age- and sex-specific Olmsted County population estimates as the denominator. Poisson regression models were used to assess the relationship of crude incidence rates to year of diagnosis, age at diagnosis, and sex. Trends in annual prevalence of major VTE risk factors were estimated using linear regression. Poisson regression with time-dependent risk factors (person-years approach) was used to model the entire population of Olmsted County and derive the PAR. The age- and sex-adjusted annual VTE incidence, 1981–2010, did not change significantly. Over the time period, 1988–2010, the prevalence of obesity, surgery, active cancer and leg paresis increased. Patient age, hospitalisation, surgery, cancer, trauma, leg paresis and nursing home confinement jointly accounted for 79 % of incident VTE; obesity accounted for 33 % of incident idiopathic VTE. The increasing prevalence of obesity, cancer and surgery accounted in part for the persistent VTE incidence. The PAR of active cancer and surgery, 1981–2010, significantly increased. In conclusion, almost 80 % of incident VTE events are attributable to known major VTE risk factors and one-third of incident idiopathic VTE events are attributable to obesity. Increasing surgery PAR suggests that concurrent efforts to prevent VTE may have been insufficient.

Supplementary Material to this article is available online at www.thrombosis-online.com.