Effects of race and ethnicity on the incidence of venous thromboembolism

doi:10.1016/S0049-3848(09)70136-7

Thrombosis Research

Volume 123, Supplement 4, 2009, Pages S11-S17

https://doi.org/10.1016/S0049-3848(09)70136-7 Get rights and content

Abstract

Although there is strong evidence that the prevalence of venous thrombo-embolism (VTE) varies significantly among different ethnic/racial groups, the genetic, physiologic and/or clinical basis for these differences remain largely undefined. African-American patients have a significantly higher rate of incident VTE, particularly following exposure to a provoking risk factor such as surgery, medical illness, trauma, etc. In addition, African-Americans are more likely to be diagnosed with pulmonary embolism (PE) than deep-vein thrombosis (DVT) compared to Caucasian and other racial groups. On the other extreme, Asians/Pacific Islanders have a 70% lower prevalence of VTE and this is true for both idiopathic VTE and provoked, or ‘secondary’, VTE. Hispanics have a significantly lower prevalence of VTE compared to Caucasians, but higher than Asians/Pacific Islanders. The incidence of recurrent VTE varies depending on gender, type of thromboembolic event and race. Further research is needed in order to determine the fundamental differences between racial/ethnic groups that explain the observed differences in the prevalence of VTE. Race/ethnicity should be considered an important factor in the risk-stratification of patients with suspected VTE or patients at some risk for developing VTE.

References (34)

B Hira et al.
Absence of factor V Leiden, thrombomodulin and prothrombin gene variants in Black South African women with preeclampsia and eclampsia
Br J Obstet Gynaecol
(2003 Mar)
WC Hooper et al.
The prevalence of the prothrombin gene variant C20209T in African-Americans and Caucasians and lack of association with venous thromboembolism
Thromb Res
(2006)
JA Heit et al.
Incidence of venous thromboembolism in hospitalized patients vs community residents
Mayo Clin Proc
(2001 Nov)
AL Klatsky et al.
Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans
Am J Cardiol
(2000 Jun 1)
AL Klatsky et al.
What protects Asians from venous thromboembolism?
Am J Med
(2004 Apr 1)
PD Stein et al.
Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census
Am J Med
(2004 Apr 1)
KY Chau et al.
Clinicopathological pattern of pulmonary thromboembolism in Chinese autopsy patients: comparison with Caucasian series
Pathology
(1997 Aug)
A Leizorovicz et al.
Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study
J Thromb Haemost
(2005 Jan)
M Sakon et al.
Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan
J Thromb Haemost
(2006 Mar)
T Baglin et al.
High risk of recurrent venous thromboembolism in men
J Thromb Haemost
(2004 Dec)

A van Hylckama Vlieg et al.

Is there a true difference in recurrence rate of deep venous thrombosis between men and women?

J Thromb Haemost

(2005 Sep)

M Cushman et al.

Hormonal factors and risk of recurrent venous thrombosis: the prevention of recurrent venous thromboembolism trial

J Thromb Haemost

(2006 Oct)

RL Bick

Hereditary and acquired thrombophilic disorders

Clin Appl Thromb Hemost

(2006 Apr)

SC Christiansen et al.

Thrombophilia, clinical factors, and recurrent venous thrombotic events

JAMA

(2005 May 18)

A Dilley et al.

Relation of three genetic traits to venous thrombosis in an African-American population

Am J Epidemiol

(1998 Jan 1)

H Itakura

Racial disparities in risk factors for thrombosis

Curr Opin Hematol

(2005 Sep)

PM Ridker et al.

Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening

JAMA

(1997 Apr 23–30)

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Effects of race and ethnicity on the incidence of venous thromboembolism

Abstract

Br J Obstet Gynaecol

Thromb Res

Mayo Clin Proc

Am J Cardiol

Am J Med

Am J Med

Pathology

J Thromb Haemost

J Thromb Haemost

J Thromb Haemost

J Thromb Haemost

J Thromb Haemost

Hereditary and acquired thrombophilic disorders

Clin Appl Thromb Hemost

Thrombophilia, clinical factors, and recurrent venous thrombotic events

JAMA

Relation of three genetic traits to venous thrombosis in an African-American population

Am J Epidemiol

Racial disparities in risk factors for thrombosis

Curr Opin Hematol

Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening

JAMA