Venous disease and pulmonary embolism

Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality in the United States. Although precise figures are difficult to obtain as a consequence of undiagnosed cases, the annual incidence of VTE has been estimated at 71 and 117 per 100,000 by two different recent retrospective population-based studies (Worcester and Olmstead Counties).1,2 Their reported annual incidences for deep venous thrombosis were nearly identical (48 per 100,000), but for pulmonary embolus (PE) there was great disparity (23 versus 69 per 100,000). This difference was believed to be secondary to the threefold higher rate of autopsy acquisition in Olmstead County as compared to the U.S. average.2 In-hospital case-fatality rates were also different, 12% versus 28%, respectively. Based on the Worcester data, Anderson and Wheeler have estimated the prevalence of clinically significant VTE at 600,000 cases per year, with as many as two-thirds of these being undiagnosed.3 Deep venous thrombosis (DVT) poses not only the immediate threat of pulmonary embolus (PE) but chronic disability secondary to venous insufficiency as well. PE is estimated to be responsible for the deaths of 50,000 to 100,000 persons per year in U.S. hospitals who would not otherwise be expected to die of their underlying disease process.4-6 Despite this awareness and evidence for the efficacy of various forms of prophylaxis, attention toward prevention remains inadequate.7