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      Thrombosis : A Major Contributor to Global Disease Burden

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          Abstract

          Thrombosis is the common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused 1 in 4 deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability.

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          Time trends in pulmonary embolism in the United States: evidence of overdiagnosis.

          Steven Woloshin, Jana Schwartz, R. Wiener (2011)
          Computed tomographic pulmonary angiography (CTPA) may improve detection of life-threatening pulmonary embolism (PE), but this sensitive test may have a downside: overdiagnosis and overtreatment (finding clinically unimportant emboli and exposing patients to harms from unnecessary treatment). To assess the impact of CTPA on national PE incidence, mortality, and treatment complications, we conducted a time trend analysis using the Nationwide Inpatient Sample and Multiple Cause-of-Death databases. We compared age-adjusted incidence, mortality, and treatment complications (in-hospital gastrointestinal tract or intracranial hemorrhage or secondary thrombocytopenia) of PE among US adults before (1993-1998) and after (1998-2006) CTPA was introduced. Pulmonary embolism incidence was unchanged before CTPA (P = .64) but increased substantially after CTPA (81% increase, from 62.1 to 112.3 per 100,000; P < .001). Pulmonary embolism mortality decreased during both periods: more so before CTPA (8% reduction, from 13.4 to 12.3 per 100,000; P < .001) than after (3% reduction, from 12.3 to 11.9 per 100,000; P = .02). Case fatality improved slightly before (8% decrease, from 13.2% to 12.1%; P = .02) and substantially after CTPA (36% decrease, from 12.1% to 7.8%; P < .001). Meanwhile, CTPA was associated with an increase in presumed complications of anticoagulation for PE: before CTPA, the complication rate was stable (P = .24), but after it increased by 71% (from 3.1 to 5.3 per 100,000; P < .001). The introduction of CTPA was associated with changes consistent with overdiagnosis: rising incidence, minimal change in mortality, and lower case fatality. Better technology allows us to diagnose more emboli, but to minimize harms of overdiagnosis we must learn which ones matter.
          Article 0 comments Cited 75 times – based on 0 reviews     Review now
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            Thrombotic risk during pregnancy: a population study.

            P.-A. Lindqvist, K Maršál, B Dahlbäck (1999)
            To determine the incidence of pregnancy-related venous thromboembolic events and the relationship to selected risk factors such as maternal age, parity, smoking, preeclampsia, or cesarean delivery. All Swedish women reported as having pregnancy-related venous thromboembolic events during 1990-1993 (608 of 479,422 deliveries) were compared with all thrombosis-free Swedish pregnant women during 1993 (114,940). The incidence of pregnancy-related venous thromboembolic events was 13 per 10,000 deliveries. Cesarean delivery was associated with a fivefold increased risk of venous thromboembolic events. Advanced age was not a significant risk factor itself, but was associated with an age-related increase in frequency of cesareans. Women with preeclampsia were at a threefold higher risk postpartum, but at no increased risk before delivery. There was a tobacco consumption-dependent increase in the risk of thrombosis among smokers. The incidence of pregnancy-related thrombosis was 13 per 10,000 and provided new insights to important risk factors such as age, cesarean delivery, smoking, and preeclampsia.
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              Prevention and treatment of venous thromboembolism--International Consensus Statement.

              A. N. Nicolaides, J Fareed, A. K. Kakkar … (2013)
              The aim of this document is to provide a clear and concise account of the evidence regarding efficacy or harm for various methods available to prevent and manage venous thromboembolism (VTE).
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Arteriosclerosis, Thrombosis, and Vascular Biology
                Abbreviated Title: Arterioscler Thromb Vasc Biol.
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 1079-5642
                ISSN (Electronic): 1524-4636
                Publication date Created: November 2014
                Publication date (Print): November 2014
                Volume: 34
                Issue: 11
                Pages: 2363-2371
                Affiliations
                [1 ]From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology–Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and...
                Article
                DOI: 10.1161/ATVBAHA.114.304488
                PubMed ID: 25304324
                SO-VID: c13ccf59-2c48-434a-ae0c-5604240baff6
                Copyright © © 2014
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