Skip Navigation
Text Size: A A A

SEQUELLAE AND COST OF VENOUS THROMBOEMBOLISM

Surgeon General's Workshop on Deep Vein Thrombosis

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14

Return to Menu


 SLIDE 1: SEQUELLAE AND COST OF VENOUS THROMBOEMBOLISM

Samuel Z. Goldhaber, MD
Cardiovascular Division
Brigham and Women’s Hospital
Professor of Medicine
Harvard Medical School
May 8, 2006

Return to Top

 SLIDE 2: DVT: A CHRONIC ILLNESS WITH OMINOUS SEQUELLAE

  • More than ½ of DVTs result in chronic venous insufficiency (QOL)
  • 30% recur over 10 years (after anticoagulation is discontinued)
  • Leads to PE, potentially fatal (QOL)
  • 4% of PEs evolve chronic thromboembolic pulmonary hypertension (QOL)

Return to Top

 SLIDE 3: STAGES OF CHRONIC VENOUS INSUFFICIENCY

  1. Varicose veins
  2. Ankle/ leg edema
  3. Stasis dermatitis
  4. Lipodermatosclerosis
  5. Venous stasis ulcer

Return to Top

 SLIDE 4: RECURRENT VTE IS COMMON AFTER A FIRST EPISODE OF SYMPTOMATIC DVT

355 patients followed for 8 years

Bar chart showing cumulative incidence increasing from less than 4 percent to almost 30 percent over 8 years.

Return to Top

 SLIDE 5: RECURRENT VTE: GENDER

Line chart showing 826 idiopathic VTE pts followed for 3 years. For reasons that remain unclear, the risk of recurrent VTE is higher among men than women

Return to Top

 SLIDE 6: RECURRENCE AFTER IDIOPATHIC VTE: 2003

TRIALTAKE-HOME POINT
PREVENTLow intensity A/C (INR 1.5-2.0) reduces recurrence rate by 2/3.
ELATEStandard A/C (INR 2.0-3.0) is more effective but as safe as low intensity A/C.
THRIVE-3Ximelagatran effective, safe.

Return to Top

 SLIDE 7: PREVENT: Recurrent VTE

Line chart showing PREVENT: Recurrent VTE. Low-intensity warfarin reduced recurrent VTE by 64 percent (P=0.0007) compared to placebo.

Return to Top

 SLIDE 8: PREVENT: Subgroups

Line chart showing PREVENT: Subgroups

PREVENT: Subgroups
Low-Intensity Warfarin Vs. Placebo

Below is a list of variables followed by the Hazard ratio (95%CI) in brackets:

Number of Prior VTE

  • 2 or more — 0.43 (0.20, 0.90)
  • 1 — 0.25 (0.08, 0.74)

Factor V Leiden or Prothrombin Mutation

  • Present — 0.25 (0.07, 0.87)
  • Absent — 0.42 (0.20, 0.86)

Gender

  • Men — 0.47 (0.23, 0.96)
  • Women — 0.20 (0.06, 0.67)

Age, years

  • 30-44 — 0.45 (0.14, 1.51)
  • 45-64 — 0.24 (0.09, 0.65)
  • 65-89 — 0.57 (0.19, 1.64)

Time after randomization

  • < 1 year — 0.27 (0.11, 0.66)
  • > 1 year — 0.49 (0.21, 1.16)

Return to Top

 SLIDE 9:

Pathology Photo

Return to Top

 SLIDE 10:

Pathology Photo

Return to Top

 SLIDE 11: ICOPER Cumulative Mortality

Line chart showing 17.5% ICOPER Cumulative Mortality at 90 days

Return to Top

 SLIDE 12:

Lung x-ray and pathology photo

Return to Top

 SLIDE 13: ESTIMATED ANNUAL COST TO TREAT DVT/ PE

  • DVT: $10,800 per patient
  • PE: $16,600 per patient
  • Recurrence increases hospitalization costs by about 20% (increased LOS)
  • Complications of anticoagulants are a cost burden
  • Time lost from work

Return to Top

 SLIDE 14: CONCLUSIONS

  1. Our concept of DVT and PE has changed. This is usually a chronic illness, analogous to CAD or diabetes.
  2. DVT and PE impair quality of life as well as threaten survival.
  3. The cost burden for acute and subsequent care is high.
  4. Costs include time lost from work and emotional suffering.

Return to Top