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  • Review Article
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Epidemiology and prevention of venous thromboembolism

Nature Reviews Cardiology volume 20, pages 248–262 (2023)Cite this article

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Abstract

Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.

Key points

  • Venous thromboembolism (VTE) surveillance systems are lacking, but VTE is estimated to affect one to two individuals per 1,000 person-years in Europe and the USA, with lower rates in other regions.

  • Risk factors for VTE are varied, and include triggers (acute and subacute), basal risk factors (demographic, behavioural, anthropometric and genetic) and acquired clinical risk factors.

  • Numerous complications can occur after a VTE event, and quality of life can decrease.

  • Reduction in the risk of VTE and adverse outcomes after a VTE event will require prevention across the spectrum of prevention stages (primordial, primary and secondary) and increased awareness of this under-appreciated condition.

  • Disparities exist in VTE incidence and outcomes; reducing these disparities will require individual, systems-based and societal commitments to equity.

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Fig. 1: Factors with protective or adverse effects on thrombosis potential and risk of VTE.
Fig. 2: Racial/ethnic differences in VTE incidence and potential underlying factors.
Fig. 3: Cumulative incidence of VTE according to genetic risk score and the AHA Life’s Simple 7.

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Acknowledgements

We graciously acknowledge A. Folsom (University of Minnesota, USA) and M. Cushman (University of Vermont, USA) for serving as our mentors and introducing us as we began our careers in VTE epidemiology. P.L.L. is supported by the NIH National Heart, Lung, and Blood Institute award K24 HL159246.

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Authors and Affiliations

  1. Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Pamela L. Lutsey

  2. Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA

    Neil A. Zakai

  3. Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA

    Neil A. Zakai

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  1. Pamela L. Lutsey
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  2. Neil A. Zakai
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Both authors contributed substantially to all aspect of the article.

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Correspondence to Pamela L. Lutsey.

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Nature Reviews Cardiology thanks Suzanne Cannegieter and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Review criteria

We provide a broad overview of the epidemiology and prevention of venous thromboembolism (VTE). Given the breadth of this topic, including an exhaustive review of the literature for each risk factor and VTE was not possible. Therefore, we tried to identify either a well-performed meta-analysis or a few representative studies for each risk factor. In general, we placed the most weight on randomized controlled trials (when available), followed by large, population-based, cohort studies, and then case–control studies or other designs. With regard to VTE anatomical sites, we focus on the deep veins of the legs and arms as well as of the pulmonary arterial vasculature. Alternative sites of thrombosis, such as cerebral sinus thrombosis and splanchnic vein thrombosis, are not reviewed in this article because, although having some shared risk factors, they are managed differently and often have very specific risk factors. Additionally, treatment is reviewed more extensively in various consensus statements, and a full review of treatment strategies is outside the scope of this Review.

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Lutsey, P.L., Zakai, N.A. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol 20, 248–262 (2023). https://doi.org/10.1038/s41569-022-00787-6

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