This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (483)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Venous Thromboembolism  • Alert me on articles by topic

A 25-Year Population-Based Study

Marc D. Silverstein, MD; John A. Heit, MD; David N. Mohr, MD; Tanya M. Petterson, MS; W. Michael O'Fallon, PhD; L. Joseph Melton III, MD

Arch Intern Med. 1998;158:585-593.

Background  The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism.

Objectives  To estimate the incidence of deep vein thrombosis and pulmonary embolism and to describe trends in incidence.

Methods  We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990.

Results  The overall average age- and sex-adjusted annual incidence of venous thromboembolism was 117 per 100000 (deep vein thrombosis, 48 per 100000; pulmonary embolism, 69 per 100000), with higher age-adjusted rates among males than females (130 vs 110 per 100000, respectively). The incidence of venous thromboembolism rose markedly with increasing age for both sexes, with pulmonary embolism accounting for most of the increase. The incidence of pulmonary embolism was approximately 45% lower during the last 15 years of the study for both sexes and all age strata, while the incidence of deep vein thrombosis remained constant for males across all age strata, decreased for females younger than 55 years, and increased for women older than 60 years.

Conclusions  Venous thromboembolism is a major national health problem, especially among the elderly. While the incidence of pulmonary embolism has decreased over time, the incidence of deep vein thrombosis remains unchanged for men and is increasing for older women. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis.

From the Department of Medicine, the Divisions of Area General Internal Medicine (Drs Silverstein and Mohr) and Cardiovascular Diseases and Section of Hematology Research (Dr Heit); the Department of Health Sciences Research, and the Sections of Clinical Epidemiology (Drs Silverstein and Melton) and Biostatistics (Ms Petterson and Dr O'Fallon), Mayo Clinic and Mayo Foundation, Rochester, Minn. Dr Silverstein is now at the Medical University of South Carolina, Charleston.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Venous Thromboembolism in Spine Surgery
Heck et al.
J Am Acad Orthop Surg 2008;16:656-664.
ABSTRACT | FULL TEXT  

Deep vein thrombosis after monoclonal gammopathy of undetermined significance and multiple myeloma
Kristinsson et al.
Blood 2008;112:3582-3586.
ABSTRACT | FULL TEXT  

Why A-level evidence does not make it to clinicians' A-list: the case of thromboprophylaxis in medical patients
Douketis and Lloyd
Evid. Based Med. 2008;13:133-134.
FULL TEXT  

Deep-Vein Thrombosis in the Elderly
Piazza et al.
CLIN APPL THROMB HEMOST 2008;14:393-398.
ABSTRACT  

High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)
Ay et al.
Blood 2008;112:2703-2708.
ABSTRACT | FULL TEXT  

High-density lipoprotein cholesterol and venous thromboembolism in the Longitudinal Investigation of Thromboembolism Etiology (LITE)
Chamberlain et al.
Blood 2008;112:2675-2680.
ABSTRACT | FULL TEXT  

Postdischarge thromboprophylaxis and mortality risk after hip-or knee-replacement surgery
Rahme et al.
CMAJ 2008;178:1545-1554.
ABSTRACT | FULL TEXT  

Development and validation of a predictive model for chemotherapy-associated thrombosis
Khorana et al.
Blood 2008;111:4902-4907.
ABSTRACT | FULL TEXT  

Sublingual administration of warfarin: a novel form of delivery
Batke-Hastings and Carman
Vasc Med 2008;13:123-126.
ABSTRACT  

Inhibition of CXCR2 attenuates bronchial angiogenesis in the ischemic rat lung
Sukkar et al.
J. Appl. Physiol. 2008;104:1470-1475.
ABSTRACT | FULL TEXT  

Review of the Relationship Between Venous Thromboembolism, Malignancy and Its Treatment
Brown and Herrington
Journal of Pharmacy Practice 2008;21:126-137.
ABSTRACT  

Superficial venous interventions: assessing the risk of DVT
Vedantham
Phlebology 2008;23:53-57.
ABSTRACT | FULL TEXT  

Pulmonary Embolism in Medical Patients: An Autopsy-Based Study
Kakkar and Vasishta
CLIN APPL THROMB HEMOST 2008;14:159-167.
ABSTRACT  

Acute Pulmonary Embolism
Tapson
NEJM 2008;358:1037-1052.
FULL TEXT  

Current Treatment of Acute Lower Extremity Deep Venous Thrombosis
Janjigian and Muhs
INT J LOW EXTREM WOUNDS 2008;7:15-20.
ABSTRACT  

The Epidemiology of Venous Thromboembolism in the Community
Heit
Arterioscler. Thromb. Vasc. Bio. 2008;28:370-372.
FULL TEXT  

CDC Division of Blood Disorders: Public Health Research Activities in Venous Thromboembolism
Beckman et al.
Arterioscler. Thromb. Vasc. Bio. 2008;28:394-395.
FULL TEXT  

Case 7-2008 -- A 17-Year-Old Girl with Chest Pain and Hemoptysis
Kinane et al.
NEJM 2008;358:941-952.
FULL TEXT  

Patient Outcomes After Deep Vein Thrombosis and Pulmonary Embolism: The Worcester Venous Thromboembolism Study
Spencer et al.
Arch Intern Med 2008;168:425-430.
ABSTRACT | FULL TEXT  

A new diagnostic rule for deep vein thrombosis: safety and efficiency in clinically relevant subgroups
Toll et al.
Fam Pract 2008;25:3-8.
ABSTRACT | FULL TEXT  

Routine Pelvic and Lower Extremity CT Venography in Patients Undergoing Pulmonary CT Angiography
Hunsaker et al.
Am. J. Roentgenol. 2008;190:322-326.
ABSTRACT | FULL TEXT  

Radiation Dose Reduction in Chest CT: A Review
Kubo et al.
Am. J. Roentgenol. 2008;190:335-343.
ABSTRACT | FULL TEXT  

Venous Thromboembolism and the Archives of Internal Medicine, 1908 to 2005
Dalen
Arch Intern Med 2008;168:14-15.
FULL TEXT  

Hospital volume and patient outcomes in pulmonary embolism
Aujesky et al.
CMAJ 2008;178:27-33.
ABSTRACT | FULL TEXT  

Chronic Kidney Disease Increases Risk for Venous Thromboembolism
Wattanakit et al.
J. Am. Soc. Nephrol. 2008;19:135-140.
ABSTRACT | FULL TEXT  

American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
Lyman et al.
JCO 2007;25:5490-5505.
ABSTRACT | FULL TEXT  

The under use of thromboprophylaxis in older medical in-patients: a regional audit
South et al.
QJM 2007;100:685-689.
ABSTRACT | FULL TEXT  

Venous thrombosis in the elderly: more questions than answers
Silverstein et al.
Blood 2007;110:3097-3101.
FULL TEXT  

Effect of Low-Dose Aspirin on the Occurrence of Venous Thromboembolism: A Randomized Trial
Glynn et al.
ANN INTERN MED 2007;147:525-533.
ABSTRACT | FULL TEXT  

Incidence of deep-vein thrombosis in patients with fractures of the ankle treated in a plaster cast
Patil et al.
J Bone Joint Surg Br 2007;89-B:1340-1343.
ABSTRACT | FULL TEXT  

Effects of Random Allocation to Vitamin E Supplementation on the Occurrence of Venous Thromboembolism: Report From the Women's Health Study
Glynn et al.
Circulation 2007;116:1497-1503.
ABSTRACT | FULL TEXT  

Venous Thromboembolism in the Outpatient Setting
Spencer et al.
Arch Intern Med 2007;167:1471-1475.
ABSTRACT | FULL TEXT  

Pharmacological Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: A Meta-analysis of Randomized Controlled Trials
Wein et al.
Arch Intern Med 2007;167:1476-1486.
ABSTRACT | FULL TEXT  

Prevalence and Significance of Asymptomatic Venous Thromboembolic Disease Found on Oncologic Staging CT
Cronin et al.
Am. J. Roentgenol. 2007;189:162-170.
ABSTRACT | FULL TEXT  

Low-molecular-weight heparin in cancer-associated thrombosis: treatment, secondary prevention, and survival
Nishioka and Goodin
J Oncol Pharm Pract 2007;13:85-97.
ABSTRACT  

Aging of Acute Deep Vein Thrombosis Measured by Radiolabeled 99mTc-rt-PA
Brighton et al.
JNM 2007;48:873-878.
ABSTRACT | FULL TEXT  

Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning
Ritchie et al.
Thorax 2007;62:536-540.
ABSTRACT | FULL TEXT  

Antithrombin Cambridge II (A384S): an underestimated genetic risk factor for venous thrombosis
Corral et al.
Blood 2007;109:4258-4263.
ABSTRACT | FULL TEXT  

Risk Factors and Short-term Mortality of Venous Thromboembolism Diagnosed in the Primary Care Setting in the United Kingdom
Huerta et al.
Arch Intern Med 2007;167:935-943.
ABSTRACT | FULL TEXT  

Thromboprophylaxis with dalteparin in medical patients: which patients benefit?
Cohen et al.
Vasc Med 2007;12:123-127.
ABSTRACT  

Haematology and neurology
Austin et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:334-341.
ABSTRACT | FULL TEXT  

Deferral of assessment of pulmonary embolism
Siragusa et al.
haematol 2007;92:410-413.
ABSTRACT | FULL TEXT  

Association of Genetic Variations With Nonfatal Venous Thrombosis in Postmenopausal Women
Smith et al.
JAMA 2007;297:489-498.
ABSTRACT | FULL TEXT  

Hospitals' compliance with prophylaxis guidelines for venous thromboembolism
Yu et al.
Am J Health Syst Pharm 2007;64:69-76.
ABSTRACT | FULL TEXT  

Thrombophilia: Common Questions on Laboratory Assessment and Management
Heit
ASH Education Book 2007;2007:127-135.
ABSTRACT | FULL TEXT  

Racial Differences in 30-Day Mortality for Pulmonary Embolism
Ibrahim et al.
Am. J. Public Health 2006;96:2161-2164.
ABSTRACT | FULL TEXT  

99mTc sestamibi uptake by acute pulmonary embolism.
Wittram et al.
Am. J. Roentgenol. 2006;187:1611-1613.
FULL TEXT  

Diagnosis and treatment of deep-vein thrombosis.
Scarvelis and Wells
CMAJ 2006;175:1087-1092.
ABSTRACT | FULL TEXT  

Incidence and Prevalence of Chronic Thromboembolic Pulmonary Hypertension: From Acute to Chronic Pulmonary Embolism
Tapson and Humbert
Proc Am Thorac Soc 2006;3:564-567.
ABSTRACT | FULL TEXT  

Choosing the Appropriate Antithrombotic Agent for the Prevention and Treatment of VTE: A Case-Based Approach
Nutescu et al.
The Annals of Pharmacotherapy 2006;40:1558-1570.
ABSTRACT | FULL TEXT  

Acute Pulmonary Embolism: Part I: Epidemiology and Diagnosis
Piazza and Goldhaber
Circulation 2006;114:e28-e32.
FULL TEXT  

Assessment of total thrombus load in symptomatic patients with venous thromboembolism.
Parakh et al.
CLIN APPL THROMB HEMOST 2006;12:369-372.
ABSTRACT  

Pulmonary Embolism as a Cause of Death in Patients With Heart Disease: An Autopsy Study
Pulido et al.
Chest 2006;129:1282-1287.
ABSTRACT | FULL TEXT  

Fatal pulmonary embolism following ankle fracture in a 17-year-old girl
Chen and Soares
J Bone Joint Surg Br 2006;88-B:400-401.
ABSTRACT | FULL TEXT  

A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism
Aujesky et al.
Arch Intern Med 2006;166:169-175.
ABSTRACT | FULL TEXT  

The Bedside Investigation of Pulmonary Embolism Diagnosis Study: A Double-blind Randomized Controlled Trial Comparing Combinations of 3 Bedside Tests vs Ventilation-Perfusion Scan for the Initial Investigation of Suspected Pulmonary Embolism
Rodger et al.
Arch Intern Med 2006;166:181-187.
ABSTRACT | FULL TEXT  

Patent Foramen Ovale: Innocent or Guilty?: Evidence From a Prospective Population-Based Study
Meissner et al.
J Am Coll Cardiol 2006;47:440-445.
ABSTRACT | FULL TEXT  

Does This Patient Have Deep Vein Thrombosis?
Wells et al.
JAMA 2006;295:199-207.
ABSTRACT | FULL TEXT  

NC100668, A NEW TRACER FOR IMAGING OF VENOUS THROMBOEMBOLISM: DISPOSITION AND METABOLISM IN RATS
Skotland et al.
Drug Metab. Dispos. 2006;34:111-120.
ABSTRACT | FULL TEXT  

Trends in the Incidence of Venous Thromboembolism during Pregnancy or Postpartum: A 30-Year Population-Based Study
Heit et al.
ANN INTERN MED 2005;143:697-706.
ABSTRACT | FULL TEXT  

Derivation and Validation of a Prognostic Model for Pulmonary Embolism
Aujesky et al.
Am. J. Respir. Crit. Care Med. 2005;172:1041-1046.
ABSTRACT | FULL TEXT  

Enoxaparin in the Treatment of Deep Vein Thrombosis With or Without Pulmonary Embolism: An Individual Patient Data Meta-analysis
Mismetti et al.
Chest 2005;128:2203-2210.
ABSTRACT | FULL TEXT  

Thoracic Ultrasound for Diagnosing Pulmonary Embolism: A Prospective Multicenter Study of 352 Patients
Mathis et al.
Chest 2005;128:1531-1538.
ABSTRACT | FULL TEXT  

Emerging Strategies in the Prevention of Venous Thromboembolism in Hospitalized Medical Patients
Spyropoulos
Chest 2005;128:958-969.
ABSTRACT | FULL TEXT  

Vena Cava Filters: Do We Know All That We Need to Know?
Ansell
Circulation 2005;112:298-299.
FULL TEXT  

Helical CT for the Evaluation of Acute Pulmonary Embolism
Patel and Kazerooni
Am. J. Roentgenol. 2005;185:135-149.
ABSTRACT | FULL TEXT  

Platelet Characteristics Change With Aging: Role of Estrogen Receptor {beta}
Jayachandran et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:815-819.
ABSTRACT | FULL TEXT  

Neuraxial Anesthesia and Low-Molecular-Weight Heparin Prophylaxis in Major Orthopedic Surgery in the Wake of the Latest American Society of Regional Anesthesia Guidelines
Rowlingson and Hanson
Anesth. Analg. 2005;100:1482-1488.
ABSTRACT | FULL TEXT  

Hypercoagulable States: A Review
Johnson et al.
VASC ENDOVASCULAR SURG 2005;39:123-133.
ABSTRACT  

Preventing Venous Thromboembolism in Medical Patients
Leizorovicz and Mismetti
Circulation 2004;110:IV-13-IV-19.
ABSTRACT | FULL TEXT  

Deferment of Objective Assessment of Deep Vein Thrombosis and Pulmonary Embolism Without Increased Risk of Thrombosis: A Practical Approach Based on the Pretest Clinical Model, D-Dimer Testing, and the Use of Low-Molecular-Weight Heparins
Siragusa et al.
Arch Intern Med 2004;164:2477-2482.
ABSTRACT | FULL TEXT  

Negative D-dimer Result To Exclude Recurrent Deep Venous Thrombosis: A Management Trial
Rathbun et al.
ANN INTERN MED 2004;141:839-845.
ABSTRACT | FULL TEXT  

Venous Thromboembolism According to Age: The Impact of an Aging Population
Stein et al.
Arch Intern Med 2004;164:2260-2265.
ABSTRACT | FULL TEXT  

Recurrent Venous Thromboembolism in Men and Women
Agnelli et al.
NEJM 2004;351:2015-2018.
FULL TEXT  

Risk of Venous Thromboembolic Disease Associated With Hormonal Contraceptives and Hormone Replacement Therapy: A Clinical Review
Gomes and Deitcher
Arch Intern Med 2004;164:1965-1976.
ABSTRACT | FULL TEXT  

The risk of venous thromboembolic disease in patients with monoclonal gammopathy of undetermined significance
Sallah et al.
Ann Oncol 2004;15:1490-1494.
ABSTRACT | FULL TEXT  

Serum Lipid Levels and the Risk of Venous Thrombosis
Doggen et al.
Arterioscler. Thromb. Vasc. Bio. 2004;24:1970-1975.
ABSTRACT | FULL TEXT  

Randomized, Placebo-Controlled Trial of Dalteparin for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients
Leizorovicz et al.
Circulation 2004;110:874-879.
ABSTRACT | FULL TEXT  

Long-term outcomes in adults with chronic ITP after splenectomy failure
McMillan and Durette
Blood 2004;104:956-960.
ABSTRACT | FULL TEXT  

Treatment of Deep-Vein Thrombosis
Bates and Ginsberg
NEJM 2004;351:268-277.
FULL TEXT  

Successful surgical management of a neonate with a saddle pulmonary embolus
De Blanche et al.
Ann. Thorac. Surg. 2004;78:e1-e2.
ABSTRACT | FULL TEXT  

Venous Thromboembolism in the Black Population
Patel et al.
Arch Intern Med 2004;164:1348-1349.
FULL TEXT  

The Risk of Recurrent Venous Thromboembolism in Men and Women
Kyrle et al.
NEJM 2004;350:2558-2563.
ABSTRACT | FULL TEXT  

Mars or Venus -- Is Sex a Risk Factor for Recurrent Venous Thromboembolism?
Elliott and Rubin
NEJM 2004;350:2614-2616.
FULL TEXT  

Role of a Quantitative D-Dimer Assay in Determining the Need for CT Angiography of Acute Pulmonary Embolism
Abcarian et al.
Am. J. Roentgenol. 2004;182:1377-1381.
ABSTRACT | FULL TEXT  

Factor V Leiden and Perioperative Risk
Donahue
Anesth. Analg. 2004;98:1623-1634.
ABSTRACT | FULL TEXT  

Single Photon Emission Computed Tomography of Pulmonary Emboli and Venous Thrombi Using Anti-D-Dimer
Morris et al.
Am. J. Respir. Crit. Care Med. 2004;169:987-993.
ABSTRACT | FULL TEXT  

Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism?
Miehsler et al.
Gut 2004;53:542-548.
ABSTRACT | FULL TEXT  

The Impact of Right Ventricular Dysfunction on the Prognosis and Therapy of Normotensive Patients With Pulmonary Embolism
Kreit
Chest 2004;125:1539-1545.
ABSTRACT | FULL TEXT  

Open pulmonary embolectomy for treatment of major pulmonary embolism
Yalamanchili et al.
Ann. Thorac. Surg. 2004;77:819-823.
ABSTRACT | FULL TEXT  

Clinical Utility of D-dimer in Patients With Suspected Pulmonary Embolism and Nondiagnostic Lung Scans or Negative CT Findings
Rathbun et al.
Chest 2004;125:851-855.
ABSTRACT | FULL TEXT  

Relationship Between Deep Venous Thrombosis and the Postthrombotic Syndrome
Kahn and Ginsberg
Arch Intern Med 2004;164:17-26.
ABSTRACT | FULL TEXT  

Symptomatic Pulmonary Embolism and the Risk of Recurrent Venous Thromboembolism
Eichinger et al.
Arch Intern Med 2004;164:92-96.
ABSTRACT | FULL TEXT  

Does This Patient Have Pulmonary Embolism?
Chunilal et al.
JAMA 2003;290:2849-2858.
ABSTRACT | FULL TEXT  

Clinical Impact of Bleeding in Patients Taking Oral Anticoagulant Therapy for Venous Thromboembolism: A Meta-Analysis
Linkins et al.
ANN INTERN MED 2003;139:893-900.
ABSTRACT | FULL TEXT  

New Pentasaccharides for the Prophylaxis of Venous Thromboembolism: Clinical Studies
Turpie et al.
Chest 2003;124:371S-378S.
ABSTRACT | FULL TEXT  

Chemokines Accumulate in the Lungs of Rats with Severe Pulmonary Embolism Induced by Polystyrene Microspheres
Zagorski et al.
J. Immunol. 2003;171:5529-5536.
ABSTRACT | FULL TEXT