title: Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality.
abstract: Venous thromboembolism (VTE) is often asymptomatic, mis-diagnosed, and unrecognized at death, and there is a lack of routine postmortem examinations. These factors are thought to result in marked underestimates ofVTE incidence. The objective of our study was to estimate the total burden of VTE within the European Union (EU) per annum. An epidemiological model was constructed to estimate the number of community- and hospital-acquired incidents and recurrent cases (attack rate) of nonfatal VTE and VTE-related deaths, as well as incident and prevalent cases of post-thrombotic syndrome (PTS) and chronic thromboembolic pulmonary hypertension (PH) occurring in the EU per annum. Individual models were developed for six EU countries. The models were populated with data from published literature and, where necessary, expert opinions. The findings were tested using probabilistic sensitivity analyses. The estimated total number of symptomaticVTE events (range based on probabilistic sensitivity analysis) per annum within the six EU countries was 465,715 (404,664-538,189) cases of deep-vein thrombosis, 295,982 (242,450-360,363) cases of pulmonary embolism (PE), and 370,012 (300,193-483,108) VTE-related deaths. Of these deaths, an estimated 27,473 (7%) were diagnosed as being antemortem; 126,145 (34%) were sudden fatal PE, and 217,394 (59%) followed undiagnosed PE. Almost three-quarters of all VTE-related deaths were from hospital-acquired VTE. VTE is a major health problem in the EU, with over one million VTE events or deaths per annum in the six countries examined. Given the availability of effective VTE prophylaxis, many of these events and deaths could have been prevented. These results have important implications for the allocation of healthcare resources.
authors.affiliation: Vascular Medicine, Department of Surgery, King's College Hospital, London, SE5 9RS, UK. alexander.cohen@kcl.ac.uk
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Cohen
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Juan I
authors.initials: JI
authors.lastname: Arcelus
authors.forename: David
authors.initials: D
authors.lastname: Bergqvist
authors.forename: Josef G
authors.initials: JG
authors.lastname: Brecht
authors.forename: Ian A
authors.initials: IA
authors.lastname: Greer
authors.forename: John A
authors.initials: JA
authors.lastname: Heit
authors.forename: Julia L
authors.initials: JL
authors.lastname: Hutchinson
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Kakkar
authors.forename: Dominique
authors.initials: D
authors.lastname: Mottier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.forename: Meyer-Michel
authors.initials: MM
authors.lastname: Samama
authors.forename: Michael
authors.initials: M
authors.lastname: Spannagl
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006761:Hospitals; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000401:mortality; D008297:Male; D009017:Morbidity; D054070:Postthrombotic Syndrome / Q000453:epidemiology / Q000401:mortality; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000401:mortality; D012042:Registries; D012306:Risk; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000401:mortality*; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000401:mortality*
chemical_list: D000925:Anticoagulants