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Chapter Three Venous Disease Coalition

Chapter Three Venous Disease Coalition. Epidemiology of VTE Risks, Risk Factors. VTE T oolkit. Acute coronary syndrome, ischemic or cardioembolic stroke, venous thromboembolic disease, acute limb ischemia Acute vascular diseases are the commonest cause of death

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Chapter Three Venous Disease Coalition

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  1. Chapter Three Venous Disease Coalition Epidemiology of VTE Risks, Risk Factors VTE Toolkit

  2. Acute coronary syndrome, ischemic or cardioembolic stroke, venous thromboembolic disease, acute limb ischemia • Acute vascular diseases are the commonest cause of death • VTE (DVT, PE) 3rd commonest vascular disease • More deaths from PE than AIDS, breast cancer and motor vehicle crashes combined • Risk of VTE increases with age Thromboembolic Disorders VTE Toolkit

  3. Affects approximately 1/1,000 people annually • DVT alone accounts for 300,000–600,000 hospitalizations each year in the USA • PE causes nearly 200,000 deaths per year in the USA • Major costs of diagnosis, treatment Thromboembolic Disorders VTE Toolkit

  4. Who Is This? VTE Toolkit

  5. Dan Blocker (HossCartright) • Of the hit TV show, Bonanza • Died of pulmonary embolism after gall bladder surgery • Age 43 VTE Toolkit

  6. Who Is This? VTE Toolkit

  7. General George S. Patton • One of the greatest generals of all time – “Old Blood and Guts” • WWII commander of the US 3rd army in Europe and North Africa • December 1945 – car accident near Heidelberg • Died of pulmonary embolism 12 days later • Age 60 • “May God have mercy on my enemies, because I won’t.” VTE Toolkit

  8. Which of these politicians have had blood clots? VTE Toolkit

  9. All of them had a blood clot! • Dick Cheney • Vice President • 2001-2009 • Dan Quayle • Vice President • 1989-1993 • Richard Nixon • President • 1969-1974 • Hillary Clinton • Secretary of State • 2009-present • Jesse Ventura • Gov. of Minnesota • 1999-2003 VTE Toolkit

  10. Who is at risk for VTE? VTE Toolkit

  11. Risk Factors • Surgery • Trauma (major trauma or leg injury) • Immobilization (bedrest, stroke, paralysis) • Cancer and its treatment (CTX, RTX, hormonal) • Acute medical illness (heart or respiratory failure, infection, inflammation) • Previous DVT or PE • Increased age • Estrogen use (BCP, HRT), pregnancy, postpartum • Central venous lines • Blood clotting disorders (thrombophilia) VTE Toolkit

  12. VTE Risk Increases with Age Residents of Worcester, MA Anderson - Arch Intern Med 1991;151:933 VTE Toolkit

  13. Population Attributable Risk for VTE Risk factor Adjusted AR Hospitalization with surgery 24% Hospitalization without surgery 22% Active cancer 18% Nursing home 13% Trauma 12% Prior CVC or pacemaker 9% Neurologic disease with leg paresis 7% (case-control study/adjusted for age, sex, year) Heit - Arch Intern Med 2002;162:1245 VTE Toolkit

  14. Symptomatic VTE after Surgery • California Patient Discharge Database (N = 1,653,275) • VTE during surgical admission or within 3 months • Thromboprophylaxis data was not available Malignant disease Craniotomy 3.6% Colectomy 1.7% Pneumonectomy 1.6% Rad. Prostatectomy 1.5% Hysterectomy 1.2% Mastectomy 0.4% Benign disease Hip replacement 2.4% Craniotomy 2.3% Knee replacement 1.7% Coronary bypass 1.1% Colectomy 1.1% Hysterectomy 0.3% TUR prostate 0.3% Lap. Cholecystectomy 0.2% White - ThrombHaemost 2003;90:446 VTE Toolkit

  15. Postoperative VTE is Associated With Increased Mortality • 118,258 surgical patients in 120 VA hospitals • Symptomatic VTE is associated with significantly increased 30-day mortality 30-day VTE Mortality No 4.4% Yes 16.9% p<0.0001 Gangireddy - J VascSurg 2007;45:335 VTE Toolkit

  16. Recurrent VTE is Common VTE is often a chronic disease 30 % 25 % 20 % 15 % 10 % 5 % Cumulative Frequency of Recurrent VTE Prandoni - Ann Intern Med 1996;125:1 0 1 2 3 4 5 6 7 8 VTE Toolkit Years Since Index DVT

  17. Post-Thrombotic Syndrome is Common • Prospective study of 355 patients with DVT • All patients advised to wear 40 mmHg stockings Pradoni – Ann Intern Med 1996; 125:1 VTE Toolkit

  18. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit

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