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Lower-Extremity Fractures or Recent Surgery Greatly Increases Risk for VTE

The risk associated with fractures and surgery was manyfold higher than the risk associated with factors such as obesity, comorbid illness, and oral contraceptive use.

In a prospective cohort study, researchers assessed the incidence of and risk factors for venous thromboembolism (VTE) in the general U.K. population. Among 1.8 million people enrolled in the General Practice Research Database and followed for 8.8 million person-years, 6550 had a new diagnosis of deep venous thrombosis, pulmonary embolism, or both.

The overall incidence of VTE was 74.5 cases per 100,000 person-years. The incidence increased strikingly with age. Fracture of a lower extremity was strongly associated with development of VTE during the next month (odds ratios, 69.4 for hip fractures and 33.2 for other lower-extremity fractures). Surgery was also a strong predictor for developing VTE, particularly within the first month after the procedure (OR, 34.4). Use of oral contraceptives and of estrogen–progesterone hormone replacement therapy was each associated with small risk increases (OR, 1.9). Other conditions that were associated with small-to-modest increases (ORs, 1.8–7.4) included recent healthcare contact, overweight, and comorbid disorders (cancer, varicose veins, heart failure, and inflammatory bowel disease).

Comment: New imaging technology and risk scores make the diagnosis of VTE much easier than in the past, but, before these can be used for diagnosis, clinicians must first consider VTE as the cause of a patient’s symptoms. Although risk factors, per se, are not particularly useful in informing us whether a particular patient has disease, recent lower- extremity fracture or surgery clearly increases risk dramatically.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine June 15, 2007

Citation(s):

Huerta C et al. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med 2007 May 14; 167:935-43.

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