Title: The Epidemiology of Venous Thromboembolism in the Community
Abstract: HomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 28, No. 3The Epidemiology of Venous Thromboembolism in the Community Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBThe Epidemiology of Venous Thromboembolism in the Community John A. Heit John A. HeitJohn A. Heit From the Divisions of Cardiovascular Diseases (Section of Vascular Diseases) and Hematology (Section of Hematology Research), Department of Internal Medicine; and the Divisions of Hematopathology and Laboratory Genetics, Department of Laboratory Medicine and Pathology; Mayo Clinic, Rochester, Minnesota. Search for more papers by this author Originally published1 Mar 2008https://doi.org/10.1161/ATVBAHA.108.162545Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:370–372Venous thromboembolism is a major health problem. The average annual incidence of venous thromboembolism among Whites is 108 per 100 000 person-years,1,2 with about 250 000 incident cases occurring annually among US whites. The incidence appears to be similar or higher among Blacks and lower among Asian- and Native-Americans.3,4 Adjusting for the different age and sex distribution of African-Americans, the venous thromboembolism incidence is about 78 per 100 000, suggesting that about 27 000 incident venous thromboembolism cases occur annually among US Blacks. Recent modeling suggests that more than 900 000 incident or recurrent, fatal and nonfatal VTE events occur in the US annually.5 The incidence of venous thromboembolism has not changed significantly over the last 25 years.2Venous thromboembolism is predominantly a disease of older age.1,2,6 Incidence rates increase exponentially with age for both men and women and for both deep vein thrombosis and pulmonary embolism.1,2,6 The overall age-adjusted incidence rate is higher for men (114 per 100 000) then women (105 per 100 000; male:female sex ratio is 1.2:1).1,2 Incidence rates are somewhat higher in women during the childbearing years, whereas incidence rates after age 45 years are generally higher in men. Pulmonary embolism accounts for an increasing proportion of venous thromboembolism with increasing age for both genders.1Survival After Deep Vein Thrombosis and Pulmonary EmbolismObserved survival after venous thromboembolism is significantly worse than expected survival for age and gender, and survival after pulmonary embolism is much worse than after deep vein thrombosis alone.7,8 The risk of early death among patients with symptomatic pulmonary embolism is 18-fold higher compared to patients with deep vein thrombosis alone.7 Pulmonary embolism is an independent predictor of reduced survival for up to 3 months after onset. For almost one-quarter of pulmonary embolism patients, the initial clinical presentation is sudden death. The annual number of pulmonary embolism–related deaths in the US may exceed myocardial infarction-related deaths and also stroke-related deaths.5Venous Thromboembolism RecurrenceVenous thromboembolism is a chronic disease with episodic recurrence; about 30% of patients develop recurrence within the next 10 years.9,10 The hazard of recurrence varies with the time since the incident event and is highest within the first 6 to 12 months. Although anticoagulation is effective in preventing recurrence, the duration of anticoagulation does not affect the risk of recurrence once primary therapy for the incident event is stopped.10,11 Independent predictors of recurrence include male gender,12 increasing patient age and body mass index, neurological disease with leg paresis, and active cancer.6,9,10,13 Additional predictors include “idiopathic” venous thromboembolism,13 a lupus anticoagulant or antiphospholipid antibody,14,15 antithrombin, protein C or protein S deficiency,16 and possibly persistently increased plasma fibrin D-dimer17 and residual venous thrombosis.18Complications of Venous ThromboembolismThe major complications of venous thromboembolism are venous stasis syndrome (ie, postthrombotic syndrome) and venous ulcer, and chronic thromboembolic pulmonary hypertension. The overall incidence of venous stasis syndrome and venous ulcer in the US is 76.1 and 18.0 per 100 000 person-years, respectively.19 Venous thromboembolism accounts for about 12% of all venous stasis syndrome cases occurring in the community.19 Venous thromboembolism patients have a 17-fold increased risk of venous stasis syndrome.19 The 20-year cumulative incidence of venous stasis syndrome after venous thromboembolism and after proximal deep vein thrombosis are about 25% and 40%, respectively.10,20,21 The 20-year cumulative incidence of venous ulcer is 3.7%.21The incidence of chronic thromboembolic pulmonary hypertension is 6.5 per million person-years.22 Applying these incidence rates to the 2000 US White population, approximately 1400 new chronic thromboembolic pulmonary hypertension cases occur in the US annually.Risk Factors for Venous ThromboembolismTo reduce venous thromboembolism incidence, persons at risk for venous thromboembolism must first be identified. Independent risk factors for venous thromboembolism include increasing patient age, surgery, trauma, hospital or nursing home confinement, active cancer with or without concurrent chemotherapy, central vein catheterization or transvenous pacemaker, prior superficial vein thrombosis, varicose veins, and neurological disease with leg paresis; patients with chronic liver disease have a reduced risk.23,24 The incidence of VTE increases significantly with age for both idiopathic and secondary VTE, suggesting that the risk associated with advancing age may be attributable to the biology of aging rather than simply an increased exposure to VTE risk factors with advancing age.25 Compared to residents in the community, hospitalized residents have more than a 100-fold increased incidence of acute venous thromboembolism.26 Hospitalization and nursing home residence together account for almost 60% of incident venous thromboembolism events occurring in the community.27 Thus, hospital confinement provides an important opportunity to significantly reduce venous thromboembolism incidence. Of note, hospitalization for medical illness and hospitalization for surgery account for almost equal proportions of venous thromboembolism (22% and 24%, respectively), emphasizing the need to provide prophylaxis to both of these risk groups. Nursing home residence independently accounts for more than one-tenth of all venous thromboembolism disease in the community.27Active cancer accounts for almost 20% of incident venous thromboembolism events occurring in the community.27 The risk appears to be higher for patients with pancreatic cancer, lymphoma, malignant brain tumors, cancer of the liver, leukemia, and colorectal and other digestive cancers.28 Cancer patients receiving immunosuppressive or cytotoxic chemotherapy are at even higher risk for venous thromboembolism.23The risk among surgery patients can be further stratified based on patient age, type of surgery, and the presence of active cancer.29,30 The incidence of postoperative venous thromboembolism is increased with advancing patient age.30,31 High-risk surgical procedures include neurosurgery, major orthopedic surgery of the leg, thoracic, abdominal or pelvic surgery for malignancy, renal transplantation, and cardiovascular surgery.30 After controlling for the type of surgery and active cancer, additional independent risk factors for venous thromboembolism within 3 months after major surgery include increasing body mass index, intensive care unit admission for 6 days or longer, a central venous catheter, prolonged immobility, varicose veins, and infection.31,32Among patients hospitalized for acute medical illness, active cancer is a major venous thromboembolism risk factor. After controlling for cancer, additional independent risk factors for venous thromboembolism within 3 months after hospitalization for acute medical illness include increasing age and BMI, neurological disease with leg paresis, fracture, chronic renal disease, central venous catheter, prior superficial vein thrombosis, and prolonged immobility.33Medical conditions associated with VTE include heparin-induced thrombocytopenia, myeloproliferative disorders (especially polycythemia rubra vera and essential thrombocytosis), intravascular coagulation and fibrinolysis/disseminated intravascular coagulation, nephrotic syndrome, paroxysmal nocturnal hemoglobinuria, thromboangiitis obliterans (Buerger disease), thrombotic thrombocytopenic purpura, Behcet syndrome, systemic lupus erythematosus, inflammatory bowel disease, homocystinuria, and possibly hyperhomocysteinemia.34,35 The risk associated with congestive heart failure, independent of hospitalization, is low.23,24 Long haul (>6 h) air travel is associated with a slightly increased risk for venous thromboembolism that is preventable with graduated compression stockings.36Among women, additional risk factors for venous thromboembolism include oral contraceptive use and hormone therapy,37 pregnancy and the postpartum period,24,38 and therapy with the selective estrogen receptor modulator, raloxifene. First and third generation oral contraceptives convey higher risk than second generation oral contraceptives.37 Hormone therapy is associated with a 2- to 4-fold increased risk of venous thromboembolism,39 but the risk may vary by type of estrogen.40 The overall incidence of pregnancy-associated venous thromboembolism is about 200 per 100 000 woman-years; compared to nonpregnant women of childbearing age, the relative risk is increased about 4-fold.38 The risk during the postpartum period is about 5-fold higher than the risk during pregnancy.38The Genetic Epidemiology of Venous ThromboembolismRecent family-based studies indicate that venous thromboembolism is highly heritable and follows a complex mode of inheritance involving environmental interaction.41,42 Inherited reductions in plasma natural anticoagulants (eg, antithrombin, protein C, or protein S) have long been recognized as uncommon but potent risk factors for venous thromboembolism.43 More recent discoveries of impaired downregulation of the procoagulant system (eg, activated protein C [APC] resistance, Factor V Leiden), increased plasma concentrations of procoagulant factors (eg, factors I [fibrinogen], II [prothrombin], VIII, IX, and XI) and increased basal procoagulant activity, impaired fibrinolysis, and increased basal innate immunity activity and reactivity have added new paradigms to the list of inherited or acquired disorders predisposing to thrombosis (thrombophilia). Inherited thrombophilias interact with such clinical risk factors (eg, environmental risk factors) as oral contraceptives, pregnancy, hormone therapy, and surgery to increase the risk of incident venous thromboembolism. Similarly, genetic interaction increases the risk of incident and recurrent venous thromboembolism. These findings support the hypothesis that an acquired or inherited thrombophilia may predict the subset of persons exposed to common risk factors who actually develop symptomatic venous thromboembolism.Sources of FundingThis work was funded, in part, by grants from the National Institutes of Health (HL66216, HL83141, HL83797, AR30582) and the Centers for Disease Control and Prevention (DD00235), US Public Health Service; and by Mayo Foundation.DisclosuresNone.FootnotesCorrespondence to Dr John A. Heit, Hematology Research, Stabile 660, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail [email protected] References 1 Silverstein M, Heit J, Mohr D, Petterson T, O’Fallon W, Melton L. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based, cohort study. Arch Intern Med. 1998; 158: 585–593.CrossrefMedlineGoogle Scholar2 Heit J, Petterson T, Farmer S, Bailey K, Melton L. Trends in Indicdence of deep vein thrombosis and pulmonary embolism: a 35-year population-based study. Blood. 2006; 108: 430a.CrossrefGoogle Scholar3 White R, Zhou H, Romano P. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California. Ann Int Med. 1998; 128: 737–740.CrossrefMedlineGoogle Scholar4 Hooper W, Holman R, Heit J, Cobb N. Venous thromboembolism hospitalizations among American Indians and Alaska Natives. Thromb Res. 2002; 108: 273–278.CrossrefMedlineGoogle Scholar5 Heit J, Cohen A, Anderson FJ. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood. 2005; 106: 267A.CrossrefGoogle Scholar6 Cushman M, Albert W, Tsai, Richard H, White G, Susan R, Heckbert S, D. W., Rosamond, Enright P, Folsom A. Deep Vein Thrombosis and Pulmonary Embolism in Two Cohorts: The Longitudinal Investigation of Thromboembolism Etiology. Am J Med. 2004; 117: 19–25.CrossrefMedlineGoogle Scholar7 Heit J, Silverstein M, Mohr D, Petterson T, O’Fallon W, Melton L. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med. 1999; 159: 445–453.CrossrefMedlineGoogle Scholar8 Janata K, Holzer M, Domanovits H, Mullner M, Bankier A, Kurtaran A, Bankl H, Laggner A. Mortality of patients with pulmonary embolism.[erratum appears in Wien Klin Wochenschr. Wiener Medizinische Wochenschrift. 2002; 114: 766–772.Google Scholar9 Heit J, Mohr D, Silverstein M, Petterson T, O’Fallon W, Melton L. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med. 2000; 160: 761–768.CrossrefMedlineGoogle Scholar10 Schulman S, Lindmarker P, Holmstrom M, Larfars S, Carlsson A, Nicol P, Svensson E, Ljungberg B, Viering S, Nordlander S, Leijd B, Jahed K, Hjorth M, Linder O, Beckmann M. Post-thrombotic syndrome, recurrence, and death 10 years after the first episode of venous thromboembolism treated with warfarin for 6 weeks or 6 months. J Thromb Haemost. 2006; 4: 732–742.CrossrefMedlineGoogle Scholar11 van Dongen C, Vink R, Hutten B, Buller H, Prins M. The incidence of recurrent venous thromboembolism after treatment with vitamin K antagonists in relation to time since first event: a meta-analysis. Arch Intern Med. 2003; 163: 1285–1293.CrossrefMedlineGoogle Scholar12 McRae S, Tran H, Schulman S, Ginsberg J, Kearon C. Effect of patient’s sex on risk of recurrent venous thromboembolism: a meta-analysis. Lancet. 2006; 368: 371–378.CrossrefMedlineGoogle Scholar13 Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet. 2003; 362: 523–526.CrossrefMedlineGoogle Scholar14 Kearon C, Gent M, Hirsch J, Weitz J, Kovacs M, Anderson D, Turpie A, Green D, Ginsberg J, Wells P, MacKinnon B, Julian J. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999; 340: 901–907.CrossrefMedlineGoogle Scholar15 Schulman S, Svenungsson E, Granqvist S. Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Duration of Anticoagulation Study Group. Am J Med. 1998; 104: 332–338.CrossrefMedlineGoogle Scholar16 van den Belt A, Sanson B-J, Simioni P, Prandoni P, Büller H, Girolami A, Prins M. Recurrence of venous thromboembolism in patients with familial thrombophilia. Arch Intern Med. 1997; 157: 227–232.CrossrefMedlineGoogle Scholar17 Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, Pengo V, Ghirarduzzi A, Pattacini C, Testa S, Lensing AWA. D-Dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006; 355: 1780–1789.CrossrefMedlineGoogle Scholar18 Prandoni P, Lensing AW, Prins MH, Bernardi E, Marchiori A, Bagatella P, Frulla M, Mosena L, Tormene D, Piccioli A, Simioni P, Girolami A. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med. 2002; 137: 955–960.CrossrefMedlineGoogle Scholar19 Heit J, Rooke T, Silverstein M, Mohr D, Lohse C, Petterson T, O’Fallon W, Melton L. Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study. J Vasc Surg. 2001; 33: 1022–1027.CrossrefMedlineGoogle Scholar20 Prandoni P, Lensing A, Cogo A, Cuppini S, Villalta S, Carta M, Cattelan A, Polistena P, Bernardi E, Prins M. The long-term clinical course of acute deep vein thrombosis. Ann Intern Med. 1996; 125: 1–7.CrossrefMedlineGoogle Scholar21 Mohr D, Silverstein M, Heit J, Petterson T, O’Fallon W, Melton L. The venous stasis syndrome after deep venous thrombosis or pulmonary embolism: a population-based study. Mayo Clin Proc. 2000; 75: 1249–1256.CrossrefMedlineGoogle Scholar22 Dunn W, Heit J, Farmer S, Petterson T, Ballman K. The incidence of chronic thormboembolic pulmonary hypertension (CTEPH): a 21-year population-based study. European Respiratory Society 13th Annual Congress, 2003.Google Scholar23 Heit J, Silverstein M, Mohr D, Petterson T, O’Fallon W, Melton L. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000; 160: 809–815.CrossrefMedlineGoogle Scholar24 Samama M-M. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients. Arch Intern Med. 2000; 160: 3415–3420.CrossrefMedlineGoogle Scholar25 Kobbervig C, Heit J, Petterson T, Bailey K, Melton L. The effect of patient age on the incidence of idiopathic vs. secondary venous thromboembolism: a population-based cohort study. Blood. 2004; 104: 957a.CrossrefGoogle Scholar26 Heit J, Melton L, Lohse C, Petterson T, Silverstein M, Mohr D, O’Fallon W. Incidence of venous thromboembolism in hospitalized patients versus community residents. Mayo Clin Proc. 2001; 76: 1102–1110.CrossrefMedlineGoogle Scholar27 Heit J, O’Fallon W, Petterson T, Lohse C, Silverstein M, Mohr D, Melton L. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002; 162: 1245–1248.CrossrefMedlineGoogle Scholar28 Heit J, Petterson T, Bailey K, Melton L. The influence of tumor site on venous thromboembolism risk among cancer patients: a population-based study. Congress of the American Society of Hematology. Blood. 2004; 104: 711a.CrossrefMedlineGoogle Scholar29 Geerts W, Pineo G, Heit J, Bergqvist D, Lassen M, Colwell C, Ray J. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126: 2297–2298.Google Scholar30 White R, Zhou H, Romano P. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost. 2003; 90: 446–455.CrossrefMedlineGoogle Scholar31 Heit J, Petterson T, Bailey K, Melton L. Risk factors for venous thromboembolism (VTE) among patients hospitalized for major surgery: a population-based case-control study. Congress of the International Society on Thromb Haemost, Sydney, Australia. Thromb Haemost. 2005; 3.MedlineGoogle Scholar32 White R, Gettner S, Newman J, Romano P. Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med. 2000; 343: 1758–1764.CrossrefMedlineGoogle Scholar33 Heit J, Petterson T, Bailey K, Melton L. Risk factors for venous thromboembolism (VTE) among patients hospitalized for acute medical illness: a population-based case-control study. Congress of the International Society on Thromb Haemost, Sydney, Australia. Thromb Haemost. 2005; 3.MedlineGoogle Scholar34 Key N, McGlennen R. Hyperhomocyst(e)inemia and thrombophilia. Arch Path Lab Med. 2002; 126: 1367–1375.CrossrefMedlineGoogle Scholar35 Heit J, Farmer S, Petterson T, Bailey K, Melton L. Novel risk factors for venous thromboembolism: a population-based, case-control study. Blood. 2005; 106: 463A.CrossrefGoogle Scholar36 Dalen J. Economy class syndrome; too much flying or too much sitting? Arch Intern Med. 2003; 163: 2674.CrossrefMedlineGoogle Scholar37 Gomez M, Deitcher S. Risk of venous thromboembolic disease associated with hormonal contraceptives and horome replacement therapy: a clinical review. Arch Intern Med. 2004; 164: 1965–1976.CrossrefMedlineGoogle Scholar38 Heit J, Kobbervig C, James A, Petterson T, Bailey K, Melton LI. Trends in the incidence of deep vein thrombosis and pulmonary embolism during pregnancy or the puerperium: A 30-year population-based study. Ann Intern Med. 2005; 143: 697–706.CrossrefMedlineGoogle Scholar39 Grady D, Wenger N, Herrington D, Khan S, Furberg C, Hunninghake D, Vittinghoff E, Hulley S. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med. 2000; 132: 689–696.MedlineGoogle Scholar40 Smith N, Heckbert S, Lemaitre R, Reiner A, Lumley T, Weiss N, Larson E, Rosendaal F, Psaty B. Esterified estrogens and conjugated equine estrogens and the risk for venous thrombosis. JAMA. 2004; 292: 1581–1587.CrossrefMedlineGoogle Scholar41 Larsen T, Sorensen H, Skytthe A, Johnsen S, Vaupel J, Christensen K. Major genetic susceptibility for venous thromboembolism in men: a study of Danish twins. Epidemiology. 2003; 14: 328–332.MedlineGoogle Scholar42 Heit J, Phelps M, Ward S, Slusser J, Petterson T, de Andrade M. Familial segregation of venous thromboembolism. J Thromb Haemost. 2004; 2: 731–736.CrossrefMedlineGoogle Scholar43 Heit J. Thrombophilia: common questions on laboratory assessment and management. Hematology. 2007; 127–135.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByHaut E, Owodunni O, Wang J, Shaffer D, Hobson D, Yenokyan G, Kraus P, Farrow N, Canner J, Florecki K, Webster K, Holzmueller C, Aboagye J, Popoola V, Kia M, Pronovost P, Streiff M and Lau B (2022) Alert‐Triggered Patient Education Versus Nurse Feedback for Nonadministered Venous Thromboembolism Prophylaxis Doses: A Cluster‐Randomized Controlled Trial, Journal of the American Heart Association, 11:18, Online publication date: 20-Sep-2022. Rauba J, Jan M, Allaqaband S, Bajwa T and Nfor T (2022) Thromboembolic clinical event rates and mortality for patients with and without inferior vena cava filter retrieval in a multicenter study, Journal of Vascular Surgery: Venous and Lymphatic Disorders, 10.1016/j.jvsv.2022.01.007, 10:4, (879-886), Online publication date: 1-Jul-2022. Aru R, Tyagi S, Ebbitt L and Patel J (2022) Comorbid conditions increase the incidence of venous thromboembolism after colorectal surgery, Surgery in Practice and Science, 10.1016/j.sipas.2022.100085, 9, (100085), Online publication date: 1-Jun-2022. Rae D (2022) The sonographer's use of spectral Doppler in the common femoral vein for the assessment of iliac vein obstructions: A retrospective audit, Sonography, 10.1002/sono.12298, 9:2, (54-61), Online publication date: 1-Jun-2022. Wiethorn E, Harrison S, Weeda E and Bell C (2021) Effectiveness and Safety of Twice- Versus Thrice-Daily Subcutaneous Heparin for Venous Thromboembolism Prophylaxis at a Large Academic Medical Center, Annals of Pharmacotherapy, 10.1177/10600280211041380, 56:5, (541-547), Online publication date: 1-May-2022. Damasco J, Huang S, Perez J, Manongdo J, Dixon K, Williams M, Jacobsen M, Barbosa R, Canlas G, Chintalapani G, Melancon A, Layman R, Fowlkes N, Whitley E and Melancon M (2022) Bismuth Nanoparticle and Polyhydroxybutyrate Coatings Enhance the Radiopacity of Absorbable Inferior Vena Cava Filters for Fluoroscopy-Guided Placement and Longitudinal Computed Tomography Monitoring in Pigs, ACS Biomaterials Science & Engineering, 10.1021/acsbiomaterials.1c01449, 8:4, (1676-1685), Online publication date: 11-Apr-2022. Martins G, Contardi E, Lopes D, de Souza T, Grangeia T, Dertkigil S, Amorim B and Ramos C (2022) Head-to-head comparison of ventilation/perfusion single photon emission computed tomography/computed tomography and multidetector computed tomography angiography for the detection of acute pulmonary embolism in clinical practice, Perfusion, 10.1177/02676591221075934, (026765912210759) MAESHIMA T, WATANABE M and ITAGAKI F (2022) Risk of Unfavorable Outcomes of Thromboembolism with Antipsychotic Drug Use: Analysis Using the Japanese Adverse Drug Event Report Database, Rinsho yakuri/Japanese Journal of Clinical Pharmacology and Therapeutics, 10.3999/jscpt.53.3, 53:1, (3-10), Online publication date: 31-Jan-2022. Sánchez-Pardo S and Rodríguez-Peralta L (2022) Pertinencia de la solicitud del dímero D en pacientes de un servicio de urgencias, MedUNAB, 10.29375/01237047.3958, 24:3, (340-346) Shahat M (2022) Aggressive management of upper extremity deep venous thrombosis – A case report and systemic review, Indian Journal of Vascular and Endovascular Surgery, 10.4103/ijves.ijves_45_21, 9:1, (118), . Asmamaw M, Hungnaw W, Motbainor A, Kedir H and Tadesse T (2022) Incidence of thromboembolism and thromboprophylaxis in medical patients admitted to specialized hospital in Ethiopia using Padua prediction score, SAGE Open Medicine, 10.1177/20503121221079488, 10, (205031212210794), Online publication date: 1-Jan-2022. Gibbs L, Moulton J and Tichenor V (2022) Venous Thromboembolism Family Medicine, 10.1007/978-3-030-54441-6_88, (1129-1143), . Shah N, Yuksel S, Sasson D, Kearney A, Neumeister M and Gosain A (2021) A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty, HAND, 10.1177/15589447211060421, (155894472110604) Butova X, Shayakhmetov S, Fedin M, Zolotukhin I and Gianesini S (2021) Artificial Intelligence Evidence-Based Current Status and Potential for Lower Limb Vascular Management, Journal of Personalized Medicine, 10.3390/jpm11121280, 11:12, (1280) Fujieda K, Nozue A, Watanabe A, Shi K, Itagaki H, Hosokawa Y, Nishida K, Tasaka N, Satoh T and Nishide K (2021) Malignant tumor is the greatest risk factor for pulmonary embolism in hospitalized patients: a single-center study, Thrombosis Journal, 10.1186/s12959-021-00334-2, 19:1, Online publication date: 1-Dec-2021. Bingzheng X, Jingnan R, Ligang B and Jianping C (2021) The effects of anticoagulant therapy re‐initiation after gastrointestinal bleeding: A systematic review and meta‐analysis, Journal of Clinical Pharmacy and Therapeutics, 10.1111/jcpt.13442, 46:6, (1509-1518), Online publication date: 1-Dec-2021. Xia W, Yu H, Chen W, Chen B and Huang Y (2021) A Radiological Nomogram to Predict 30-day Mortality in Patients with Acute Pulmonary Embolism, Academic Radiology, 10.1016/j.acra.2021.11.021, Online publication date: 1-Dec-2021. Sucharitha D, Sai D, Lahari M and Bee M (2021) Computer Assisted System for Detecting Pulmonary Embolism in Lungs, International Journal of Recent Technology and Engineering (IJRTE), 10.35940/ijrte.D6584.1110421, 10:4, (89-94) Karataş M, Yelgeç N, Çanga Y, Zengin A and Emre A (2020) Association of digoxin therapy with case fatality rate in acute pulmonary embolism, Wiener klinische Wochenschrift, 10.1007/s00508-020-01773-z, 133:21-22, (1171-1178), Online publication date: 1-Nov-2021. Cherepanova N and Duplyakov D (2021) Chronic thromboembolic pulmonary hypertension after an acute pulmonary embolism: fundamental concepts of diagnosis and review of current treatment options, Russian Journal of Cardiology, 10.15829/1560-4071-2021-4588, 26:3S, (4588) Michels A, Swystun L, Dwyer C, Rawley O, Nesbitt K, Notley C and Lillicrap D (2021) Stabilin‐2 deficiency increases thrombotic burden and alters the composition of venous thrombi in a mouse model, Journal of Thrombosis and Haemostasis, 10.1111/jth.15429, 19:10, (2440-2453), Online publication date: 1-Oct-2021. Bikdeli B, Hogan H, Morrison R, Fanikos J, Campia U, Barns B, Pfeferman M, Snyder J, Khairani C, Goldhaber S and Piazza G (2021) Extended-Duration Low-Intensity Apixaban to Prevent Recurrence in Patients with Provoked Venous Thromboembolism and Enduring Risk Factors: Rationale and Design of the HI-PRO Trial, Thrombosis and Haemostasis, 10.1055/a-1646-2244 ÇORAPLI G and TOPÇU A (2021) Combination of the Simplified Modified Geneva and Wells Clinical Prediction Scoring promise a good performance in pulmonary embolism diagnosis, Journal of Surgery and Medicine, 10.28982/josam.962221, 5:9, (828-831) BOLAT A and GÜLTEKİN Y (2021) VENA SAFENA MAGNANIN ANATOMİK VARYASYONU DERİN VEN TROMBOZU İÇİN BİR RİSK FAKTÖRÜ MÜDÜR?, Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 10.24938/kutfd.916762, (343-350) Becattini C, Cimini L and Agnelli G (2021) Home management or hospital admission for low-risk pulmonary embolism? Clinical scores versus pragmatic assessment, European Heart Journal, 10.1093/eurheartj/ehab491, 42:33, (3158-3160), Online publication date: 31-Aug-2021. Castaldi M, George G, Stoller C, Parsikia A and McNelis J (2020) Independent Predictors of Venous Thromboembolism in Patients Undergoing Reconstructive Breast Cancer Surgery, Plastic Surgery, 10.1177/2292550320967397, 29:3, (160-168), Onli