Risk Factors For Venous Thromboembolism

In order to improve survival, avoid recurrence, prevent complications, and reduce health care costs, the occurrence of venous thromboembolism must be reduced. To reduce venous thromboembolism incidence, persons at risk for venous thromboembolism first must be identified. Independent risk factors for venous thromboembolism include patient age, surgery, trauma, hospital or nursing home confinement, active malignant neoplasm with or without concurrent chemotherapy, central vein catheterization or transvenous pacemaker, prior superficial vein thrombosis, varicose veins among the young, and neurological disease with extremity paresis; patients with chronic liver disease have a reduced risk (see Table 36.4).42,43 The incidence of VTE increases significantly with age for both idiopathic and secondary VTE, suggesting that the risk associated with advancing age may be due to the biology of aging rather than simply an increased exposure to VTE risk factors with advancing age.44 Compared to residents in the community, hospitalized residents have over a 150-fold increased incidence of acute venous thromboembolism.45 Hospitalization and nursing home residents together account for almost 60% of incident venous thromboembolism events occurring in the community.46 Thus, hospital confinement provides an important opportunity to significantly reduce venous throm-boembolism incidence. Of note, hospitalization for medical illness and hospitalization for surgery account for almost

TABLE 36.4 Independent Risk Factors for Deep Vein Thrombosis or Pulmonary Embolism42

Baseline characteristic Odds ratio 95% CI

Institutionalization with or without recent surgery

TABLE 36.4 Independent Risk Factors for Deep Vein Thrombosis or Pulmonary Embolism42

Baseline characteristic Odds ratio 95% CI

Institutionalization with or without recent surgery

Institutionalization without

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