Surgeon General's Workshop on Deep Vein Thrombosis: Workshop Presentations

Surgeon General's Workshop on Deep Vein Thrombosis

SEQUELLAE AND COST OF VENOUS THROMBOEMBOLISM

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

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

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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)

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SLIDE 3: STAGES OF CHRONIC VENOUS INSUFFICIENCY

Varicose veins
Ankle/ leg edema
Stasis dermatitis
Lipodermatosclerosis
Venous stasis ulcer

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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.

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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

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SLIDE 6: RECURRENCE AFTER IDIOPATHIC VTE: 2003

TRIAL	TAKE-HOME POINT
PREVENT	Low intensity A/C (INR 1.5-2.0) reduces recurrence rate by 2/3.
ELATE	Standard A/C (INR 2.0-3.0) is more effective but as safe as low intensity A/C.
THRIVE-3	Ximelagatran effective, safe.

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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.

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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)

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SLIDE 9:

Pathology Photo

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SLIDE 10:

Pathology Photo

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SLIDE 11: ICOPER Cumulative Mortality

Line chart showing 17.5% ICOPER Cumulative Mortality at 90 days

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SLIDE 12:

Lung x-ray and pathology photo

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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

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SLIDE 14: CONCLUSIONS

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

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