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Venous thromboembolism in Jamaican women: experience in a university hospital in Kingston.

OBJECTIVE
To review cases of venous thromboembolism (VTE) at UHWI from 1999-2004, to identify methods of diagnosis, risk factors and to evaluate differences between survivors and fatalities.


METHODS
Patients coded with the diagnosis of thromboembolism at the University Hospital of the West Indies (UHWI) from 1999-2004 were identified. The medical records were reviewed to determine the prevalence of thromboembolism and possible variables associated with this diagnosis. In addition, variables associated with fatality were examined by evaluating cases diagnosed at autopsy


RESULTS
There were 959 patients coded for thromboembolism between 1999-2004 at UHWI. Of these, 657 (68.5%) were females and 302 were males (31.5%). During that period, 65,657 women and 40,826 men were admitted to hospital with prevalence rates for thromboembolism of 1% in women and 0.7% in men. Of the 657 females, 520 case notes were located (case identification 80%). Of this, 435 were analysed as confirmed thromboembolism. The median age was 51 years with a range of 2-95 years. Common associations were obesity, 53.5%; age over 50 years, 52.5%; hypertension, 44.7%; immobilisation, 36.3%; cardiac disease, 26%; diabetes, 19.4%; fibroids, 16.3%; surgery, 15.8% and cancer 14%. Recurrent venous thromboembolism occurred in 12.8% and 15.8 % of women (66) died, diagnosed with PE at post-mortem. Using logistic regression analysis, leading risk factors in fatalities compared to survivors were hypertension and increased age. Obesity and surgery were significantly more likely in survivors.


CONCLUSION
Venous thromboembolism was common in this cohort of women and avoidance of risk factors and institution of prophylaxis in high risk women is important to decrease morbidity and mortality.