Epidemiology of venous thromboembolism in Africa: a systematic review

Abstract

Background Venous thromboembolism (VTE) is among the three leading causes of cardiovascular disease worldwide. Despite its high burden, there has been no previous study summarizing the epidemiology of VTE in African populations. Hence, we conducted this systematic review to determine the prevalence, incidence and mortality associated with VTE, and to evaluate the use of VTE prophylaxis in Africa. Methods We searched PubMed, Scopus and African Journals Online to identify articles published on VTE in Africa from inception to November 19, 2016, without language restriction. The reference list of eligible articles were further scrutinized to identify potential additional studies. Results Overall, we included 21 studies. The great majority of the studies yielded a moderate risk of bias. The prevalence of deep vein thrombosis (DVT) varied between 2.4% and 9.6% in postoperative patients, and between 380 and 448 per 100 000 births per year in pregnant and postpartum women. The prevalence of pulmonary embolism (PE) in medical patients varied between 0.14% and 61.5%, with a mortality rate of PE between 40% and 69.5%. The case-fatality rate after surgery was 60%. Overall, 31.7-75% of the patients were at risk of VTE, and between 34.2% and 96.5% of these received VTE prophylaxis. Conclusion The prevalence of VTE and associated mortality are high following surgery, and in pregnant and postpartum women in Africa. At least one-quarter of patients who are at risk for VTE in Africa are not receiving prophylaxis. These results are generated from studies with small sample size, highlighting an urgent need for well-designed studies with larger sample size to evaluate the true burden of VTE in Africa.

Thrombo-Embolism Risk and Prophylaxis amongst Hospitalized Patients in Two Hospitals in Cameroon: A Cross-sectional Study in Sub-Saharan Africa

“…The high risk burden and low rates of adequate thrombo-prophylaxis for VTE in this semi-urban and rural hospitals is comparable to that reported in urban tertiary hospitals in Africa and beyond [9][10][11]18]. This is however associated with high rates of younger age groups, Table 3 shows the pre-admission and admission risk factors for VTE.…”

“…Besides the increase in the morbidity, the mortality is expected to be higher due to the low purchasing power of the patients, the poorly equiped hospitals (consumables, materials, and personnel), and poor health system (no health coverage). The exact burden of VTE is not known in this setting, as it may go undiagnosed and under-reported [11]. It is a disease condition that is largely underdiagnosed and under-treated despite the very high disease burden in hospitalized patients worldwide [6].…”

“…The burden of VTE has not been well characterized in Low-Middle Income (LMIC) settings, especially in sub-Saharan Africa (SSA) [11]. Few studies in tertiary urban hospitals have assessed the prevention and treatment of VTE [12,13].…”

Hypertension prevalence, associated factors, treatment, and control in rural Cameroon: a cross-sectional study

“…Cardiovascular diseases are the second commonest cause of premature disability and death in sub-Sahara Africa (SSA) [4][5][6]. A greater bulk of the burden of heart disease, kidney failure, stroke and premature death in this region is accounted for by hypertension [7][8][9][10].…”

Fatality rates and use of systemic thrombolysis in pregnant women with pulmonary embolism

“…Acute venous thromboembolism complicates one in 500-3000 pregnancies [1][2][3] and represents a leading cause of death among younger women in Western countries. [4][5][6][7] A recent analysis of medically certified vital registration data in Europe demonstrated that, despite an overall decreasing trend in age-standardized pulmonary embolism-related mortality, more than 1% of all deaths in younger women are due to pulmonary embolism.…”