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A Population-Based Case-Control Study

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

Arch Intern Med. 2000;160:809-815.

Background  Reported risk factors for venous thromboembolism (VTE) vary widely, and the magnitude and independence of each are uncertain.

Objectives  To identify independent risk factors for deep vein thrombosis and pulmonary embolism and to estimate the magnitude of risk for each.

Patients and Methods  We performed a population-based, nested, case-control study of 625 Olmsted County, Minnesota, patients with a first lifetime VTE diagnosed during the 15-year period from January 1, 1976, through December 31, 1990, and 625 Olmsted County patients without VTE. The 2 groups were matched on age, sex, calendar year, and medical record number.

Results  Independent risk factors for VTE included surgery (odds ratio [OR], 21.7; 95% confidence interval [CI], 9.4-49.9), trauma (OR, 12.7; 95% CI, 4.1-39.7), hospital or nursing home confinement (OR, 8.0; 95% CI, 4.5-14.2), malignant neoplasm with (OR, 6.5; 95% CI, 2.1-20.2) or without (OR, 4.1; 95% CI, 1.9-8.5) chemotherapy, central venous catheter or pacemaker (OR, 5.6; 95% CI, 1.6-19.6), superficial vein thrombosis (OR, 4.3; 95% CI, 1.8-10.6), and neurological disease with extremity paresis (OR, 3.0; 95% CI, 1.3-7.4). The risk associated with varicose veins diminished with age (for age 45 years: OR, 4.2; 95% CI, 1.6-11.3; for age 60 years: OR, 1.9; 95% CI, 1.0-3.6; for age 75 years: OR, 0.9; 95% CI, 0.6-1.4), while patients with liver disease had a reduced risk (OR, 0.1; 95% CI, 0.0-0.7).

Conclusion  Hospital or nursing home confinement, surgery, trauma, malignant neoplasm, chemotherapy, neurologic disease with paresis, central venous catheter or pacemaker, varicose veins, and superficial vein thrombosis are independent and important risk factors for VTE.

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

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