Relative Impact of Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism

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Abstract
VENOUS THROMBOEMBOLISM (ie, deep vein thrombosis and its complication, pulmonary embolism) is a common disease, with an average annual incidence rate of more than 1 per 1000.1 Venous thromboembolism also is a lethal disease, mostly owing to pulmonary embolism. The 1-week survival rate after a pulmonary embolism is only 71%, and almost 25% of all cases of pulmonary embolism essentially present as sudden death.2 Survivors may experience serious and costly long-term complications. Almost 30% of patients develop serious venous stasis syndrome within 10 years,3,4 at an estimated cost of more than $4000 per episode in 1997 dollars.5 To improve survival and to prevent complications, the occurrence of venous thromboembolism must be reduced. Independent risk factors for venous thromboembolism have been identified,6 and effective prophylaxis is available for certain subgroups.7 However, the incidence of venous thromboembolism, both arising in the hospital as well as in the general population, has remained relatively constant since about 1980.1,8 This could reflect either an increase in the population at risk (eg, an increase in the average population age) or exposure of the population to more or new risk factors (eg, an increase in surgical procedures).9 Additional possibilities include inadequate identification of high-risk populations and underuse of appropriate prophylaxis.10,11 To address the potential impact of universal prophylaxis or modification of currently recognized risk factors (if either were possible) on the incidence of venous thromboembolism in the community, we used data from a population-based case-control study6 to estimate the population attributable risk (defined as the percentage of all cases of a disease in a population that can be "attributed" to a risk factor) for venous thromboembolism associated with specific risk factors, both individually and for all risk factors collectively, while adjusting for other factors.