Pulmonary Thromboembolism. Light and Shadows

In recent years, we have obtained new data about venous thromboembolism (VTE)—a term covering deep vein thrombosis (DVT) and pulmonary embolism (PE)—that have substantially increased interest in the problem. According to the Study on Thromboembolism in Spain,1 incidence of VTE diagnosed in-hospital is approximately 124 cases per 100 000 individuals. This represents about 55 000 new cases and 30 000 admissions per year. In direct hospital costs alone, it amounts to 60 million euros annually, of which PE accounted for 40 million euros in 2005.1 Clearly, diagnosis of VTE has improved and become more frequent. Moreover, diagnosis is often linked to healthcare, as demosnstrated the 50% increase in secondary diagnosis of VTE in discharge reports over 5 years.1 The greater availability of multislice computed tomography (CT) explains the increased diagnosis of PE (up 50% in 1999-2003) but diagnosis of DVT has remained stable.1 Currently, we have access to an online registry providing updated information on the characteristics (Table) and clinical course of patients attended in daily practice in many of our hospitals (available at: http://www.riete.org). In contrast, PE is the third cause of inhospital death and an important cause of death in the general population. A recent Europeanepidemiologic study2 calculated VTE causes 12% of deaths in the European population—more than diseases like AIDS, breast or prostate cancer, and traffic accidents together (543 454 and 209 926 deaths per year, respectively). In clinical practice, only 7% of deaths from PE are recognized as such because they occur during treatment for a previously-diagnosed disease. Real mortality may be up to 14 times greater.2 In many patients, PE is the direct cause of death whereas in others, it is an epiphenomenon contributing to the death of patients with Pulmonary Thromboembolism. Light and Shadows