Venous thromboembolism disease in internal medicine: epidemiological trends, etiological factors, and management patterns. A five-year retrospective observational study at Laghouat Mixed Hospital.

Abstract

Introduction: Venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening condition associated with substantial morbidity, mortality, and healthcare burden. In Algeria, particularly in southern regions, epidemiological and management data remain limited. Objective: To assess the hospital prevalence of VTE in the Internal Medicine Department of Laghouat Mixed Hospital and to describe its epidemiological profile, etiological factors, clinical characteristics, therapeutic management, and in-hospital outcomes over a five-year period (January 1, 2021 to December 31, 2025). Materials and Methods: This was a retrospective descriptive study conducted over five years. Among 5,968 hospitalizations recorded in the Internal Medicine Department, all patients with clinically, biologically, and imaging-confirmed VTE were included. Demographic, risk factor, localization, clinical, etiological, therapeutic, and outcome data were collected from medical records and analyzed descriptively. Results: A total of 267 confirmed VTE cases were identified, corresponding to a hospital prevalence of 4.47%. Cases increased progressively over the study period, with the highest number recorded in 2025 (22.8%). The mean age was 50.8 ± 19.9 years (range: 16–92), with a female predominance (64.8%; sex ratio: 0.54). Regarding anatomical distribution, lower-limb DVT was the most frequent localization (45.5%), followed by pulmonary embolism (17.9%) and cerebral venous thrombosis (14.1%). Isolated DVT accounted for 69.6% of cases, isolated PE for 21.5%, and combined DVT with PE for 8.8%. Less frequent sites included upper-limb, splanchnic, and unusual venous thromboses. Clinically, the most common manifestations were limb edema, warmth, and redness (33.1%), limb pain (17.7%), and dyspnea (9.6%). Etiologically, the main causes were idiopathic or unprovoked VTE (31%), active cancer (17.2%), immobilization, surgery, or trauma (16.7%), and thrombophilia (14.3%). Women were more frequently exposed to hormonal and pregnancy-related factors, whereas men more often presented with cancer-associated or idiopathic events, COVID-19 was found (8.6%) as prothrombotic risk factor. Younger patients were more commonly affected by thrombophilia, cerebral venous thrombosis, and hormonal causes, while older patients predominantly presented with cancer-related VTE and transient acquired risk factors. Therapeutically, initial treatment was mainly based on low-molecular-weight heparin (85.8%). Maintenance therapy was dominated by vitamin K antagonists (53.5%), followed by direct oral anticoagulants (21.4%). Clinical evolution was favorable in 88.8% of patients. The in-hospital complication rate was 9.7%, while mortality reached 7.1%, with the highest rates observed in cancer-associated VTE. Conclusion: VTE is a frequent and heterogeneous condition in internal medicine practice at Laghouat Mixed Hospital, predominantly affecting women and middle-aged adults. Lower-limb DVT remains the most common presentation, while cerebral venous thrombosis and thrombophilia were notable in younger patients. Idiopathic cases remain frequent, whereas cancer represents the main predictor of poor prognosis. LMWH and VKA remain the cornerstone of treatment, while DOAC use is increasing but still limited. Strengthening prevention, early diagnosis, thrombophilia screening in selected patients, and broader access to modern anticoagulation strategies may improve outcomes.