Epidemiology and Risk Factors

In 2003 there were 98,921 hospitalizations in the United States during which pulmonary embolism was diagnosed, generating charges of nearly $2 billion. In-hospital mortality was 3% (Health Care Utilization Project,, 2003). The importance of rapid diagnosis and treatment was underscored by Dalen and Alpert in 1975, who estimated that only 6% of PE deaths at that point in medical history occurred in patients diagnosed and treated for PE (Dalen, 2002).

The most important cause of pulmonary embolism is DVT, and both conditions are included under the broader term venous thromboembolism (VTE). Virchow's triad of risk included hypercoagulability, stasis, and vascular injury. Patients can develop DVT after surgery (especially hip or pelvic surgery), major trauma, prolonged hospitalization or bed confinement, or even prolonged sitting in a confined space (air travel, bus or car trips, medical school lectures). Patients at highest risk are those with a past history of DVT. Additional risk factors include smoking, cancer, obesity, pregnancy, heart disease, stroke, burns, and medications (e.g., estrogen therapy). Patients with inherited risk include those with antithrombin III deficiency, hyperhomocysteinemia, protein C or protein S deficiency, and factor V Leiden mutation, as well as those with acquired hypercoagulable states such as the antiphospholipid syndrome.

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