VTE epidemiology and challenges for VTE prevention at the population level

Venous thromboembolism (VTE) is a frequent disease affecting more than 1 in 12 individuals during their lifetime. VTE is associated with a substantial disease burden due to long-term complications such as recurrence, the post-thrombotic syndrome, and the post-pulmonary embolism syndrome. Despite the knowledge of several risk factors and triggers, more than one third of the VTE events occur in the absence of an obvious provoking factor. In this narrative review, we summarize studies presenting time trends in incidence rates of VTE after year 2000 and discuss potential reasons for the incidence trends as well as challenges for VTE prevention at the population level. Studies from US, Europe and Asia indicate that the incidence rates of VTE have increased slightly during the last twenty years. Of note, this increase has persisted beyond the implementation of computed tomography pulmonary angiography (CTPA) into routine clinical practice. The persisting rates are likely attributed to the concomitant increase in major risk factors for VTE, such as obesity, major surgery, and cancer. Apparently, more widespread use of thromboprophylaxis to high-risk groups have not counteracted the rates noticeably, indicating that an approach to change the risk factor profile in the general population may be warranted. Obesity is recognized as the strongest causal lifestyle factor for VTE with a population attributable fraction of 10–30%. However, the mechanisms by which obesity increases the VTE risk are poorly understood. By integrating multi-omics and system biology approaches, future epidemiological studies should focus on identifying biological pathways that drive thrombogenesis to reveal disease mechanisms and potential targets for prevention.