Thromboembolic diseases: a major global health concern
(VTE) is a major public health problem worldwide, contributing to an estimated >500,000 deaths in Europe and up to 300,000 deaths in the United States (US) each year.12, 144 VTE
creates a major burden on healthcare systems145, 292
with management of the condition often extending far beyond the initial event. Patients undergoing major orthopaedic surgery for total hip or total knee replacement or surgery for fracture of the hip are at particularly high risk of deep vein thrombosis (DVT) and may develop pulmonary embolism (PE).293
Awareness of these conditions has risen with public health scares about the risk of DVT on long-distance flights and high rates of PE in patients recovering from major surgery.1, 2
However, insufficient prophylaxis
remains a major problem despite extensive evidence that primary preventive therapy effectively reduces the risk of DVT, PE and fatal PE.57, 293
Atrial fibrillation (AF), the most common form of cardiac arrhythmia
can lead to the formation of thrombi in the heart. Thrombi that form in the heart are the main cause of stroke in people with AF.18
These thrombi can travel in the circulation and become lodged in the brain causing an embolism that can result in an ischaemic stroke
or transient ischaemic attack (TIA).150, 294
It is expected that the number of patients with AF will increase in the future.79, 295
Projected increase in number of patients with AF by 2050. 295, 79
AF, atrial fibrillation.
- 12 - Cohen AT, Agnelli G, Anderson FA, et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost. 2007;98(4):756-764.
- 144 - Heit JA, Cohen AT, Anderson FA, on behalf of the VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. [Abstract 910]. Blood 2005;106(11):267a.
- 145 - House of Commons Health Committee. The prevention of venous thromboembolism in hospitalised patients.
- 292 - Guanella R, Ducruet T, Johri M et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost 2011;9:2397–2405.
- 293 - Falck-Ytter Y, Francis CW, Johanson NA et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e278S–e325S.
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- 57 - Cohen AT, Tapson VF, Bergmann JF, et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-394.
- 22 - Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257-e354.
- 18 - Waldo AL. Anticoagulation: stroke prevention in patients with atrial fibrillation. Med Clin North Am. 2008;92(1):143-159, xi.
- 150 - Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983– 988.
- 294 - Turpie AGG, Esmon C. Venous and arterial thrombosis – pathogenesis and the rationale for anticoagulation. Thromb Haemost 2011;105:586–596.
- 79 - Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285(18):2370-2375.
- 295 - Miyasaka Y, Barnes ME, Gersh BJ et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114:119–125.
- 296 - Lichtlen PR, Nikutta P, Jost S et al. Anatomical progression of coronary artery disease in humans as seen by prospective, repeated, quantitated coronary angiography. Relation to clinical events and risk factors. The INTACT Study Group. Circulation 1992;86:828–838.
- 5 - Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005;46(6):937-954.
- 297 - Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ 2003;326:1259–1261.
- 298 - Fox KA, Steg PG, Eagle KA et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007;297:1892–1900.
- The prevention of a disease or pathological condition.
- Venous thromboembolism
- A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE. The term encompasses both DVT and PE.
- Any variation from the normal rhythm of the heart beat (e.g., sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia).
- Ischaemic stroke
- Potentially fatal brain damage due to interrupted blood supply to the brain caused by thrombosis or an embolism.
- Acute coronary syndrome
- This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.
- Heart condition characterised by intermittent chest pain. Angina usually results from coronary artery disease and may further be classified as stable or unstable angina. Stable angina refers to the more common understanding of angina related to myocardial ischemia. Unstable angina may occur unpredictably at rest which may be a serious indicator of an impending heart attack.
- Coronary artery disease
- Coronary artery disease (CAD) is the end result of the accumulation of plaques within the walls of the arteries that supply the muscle of the heart with oxygen and nutrients. The process by which the coronary arteries become narrowed or completely occluded is known as atherosclerosis.
- Myocardial infarction
- Destruction of heart tissue due to reduced blood flow to the heart. Also known as a heart attack. It usually results from coronary artery disease and is more severe than angina.