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Update on venous thromboembolism: risk factors, mechanisms, and treatments.

Deep vein thrombosis (DVT) and pulmonary embolism, collectively called venous thromboembolism (VTE), are a public health crisis. The number of incident and recurrent VTE events are estimated at more than 1 million per year.1 Beyond the initial risk of death, estimated at greater than 30% within 30 days of the event, one third to one half of surviving patients develop recurrent thrombosis or long-term morbidity associated with postthrombotic syndrome.2,3 The economic burden of VTE is substantial; treatment of a single VTE event costs from $10 000 to more than $16 000 per person.4 Consequently, each year more than $2 billion dollars is spent on VTE treatment, attributable to costs associated with both new and recurrent events.4 Moreover, the impact of VTE is increasing with the growing aging population; risk rises from 1/10 000 at birth to 1/100 in individuals older than 80 years.1 Because pulmonary embolism risk rises faster than DVT, the relative incidence of pulmonary embolism, and therefore the fatal impact of VTE, also increases with age.1,5 Clearly, the health and economic burden of VTE is profound, and the need for improved understanding and treatment is essential.

In 2005, the United States Senate designated March “Deep Vein Thrombosis Awareness Month.”6 A PubMed search for “‘venous thrombosis' or ‘pulmonary embolism'” in the 5 years before (2000 to 2004) versus the 5 years after (2005 to 2009) this designation reveals that publications increased ≈17% following the Senate's call. Of particular note are the more than 900 publications from clinical trials of VTE prevention and treatment between 2005 and 2009, underscoring the impact of VTE in the translational arena. Unfortunately, however, clinical progress is still limited by a deficit in understanding of the etiology and pathogenesis of …