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Adequate management of venous thromboembolism.

as a common disease and even in Japan, the prevalence of VTE has been increasing in association with the increasing spread of a western lifestyle, aging, increased awareness of VTE, and advances in diagnostic techniques.7,8 In the issue of this journal, Nakamara et al9 report their results from the nationwide Japan Venous Thromboembolism Treatment (JAVA) observational study, including the incidence of VTE in Japan and the recent status of VTE management and outcomes. The authors found a low incidence of VTE, reflecting the results of previous studies. However, the JAVA study was not designed to assess the incidence of VTE. Hence, further investigation is still necessary to clarify the actual number of VTE cases in the general population of Japan. In addition, the authors found that the prognosis of VTE depended on background factors and the choice of therapy. Therefore, early detection of VTE and adequate management of risk factors for VTE are important to prevent serious complications. The common independent risk factors for VTE are listed in the Table. They include surgery, hospitalization for acute medical illness, trauma, active cancer, immobilization, superficial vein thrombosis, central venous catheter/transvenous pacemaker, and hormone therapy.10 In the JAVA study, a medical history of cancer was observed to be the most common VTE risk factor, being present in 27.0% of patients with VTE. Concomitant acute medical illness was found in approximately enous thromboembolism (VTE), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent disease that has potentially serious complications. PE is a major life-threatening complication for patients with VTE because it can lead to the sudden collapse of circulatory dynamics and subsequent death. The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) among survivors of acute PE is approximately 1%.1 CTEPH results from the obstruction of pulmonary arteries by unresolved, organized thrombi. In untreated patients, CTEPH may progress to right heart failure and death. A study of patients with inoperable CTEPH showed that prognosis was poor (5-year survival ≈30%), especially for patients with a mean pulmonary artery pressure >40 mmHg.2 Bosentan and sildenafil are used as modern oral therapy for patients with inoperable CTEPH. Medically treated patients with CTEPH have a better survival rate, and the use of bosentan and sildenafil contributes to this improved survival.3 The incidence of VTE is approximately 7 per 10,000 person-years among community residents,4 and it has recently become a common preventable cause of hospital death.5,6