Background:
Venous thromboembolism (VTE) presenting as pulmonary embolism (PE) and deep venous thrombosis (DVT) represents the third most common cause of cardiovascular death, after myocardial infarction and cerebrovascular insults and is a leading preventable cause of death among hospitalized patients. The incidence of PE is approximately 60 to 70 per 100000 population; its management remains a serious health problem. VTE is considered a part of the cardiovascular disease group, sharing similar predisposing factors such as hypertension, diabetes, obesity, hypercholesterolemia and smoking. Smoking is considered an intermediate risk factor for PE and an independent predictor associated with higher readmission rate.

Objective:
To determine whether smoking is an independent risk factor for venous thromboembolism.

Methods:
We analyzed the data from the Registry for pulmonary embolism at the Clinic of Pulmonology and Allergy in Skopje. In the period from October 2011 to December 2021, a total of 309 patients were hospitalized with radiologically confirmed PE, 169 (54.7%) male and 140 (45.3%) female. Smoking status was registered as never smoker, active smoker and previous (ex-)smoker.

Results:
In all, 131 (42.4%) of the patients with acute PE were active smokers, 132 (42.7%) never smoked, 42 (13.6%) were ex-smokers with total smoking history over 15 pack/years. For 4 (1.3%) of the patients we could not collect accurate data. The total of active and ex-smokers adds up to 56% of the total number of patients, which is almost double than the referred prevalence of smoking in Macedonia according to the Tobacco Atlas from 2015 (36.1% in males and 20.8% in females).

Conclusions:
No significant difference was registered concerning predisposition for bleeding, comorbidities, duration of hospitalization. Persistence of thrombi and recidivant PE was more prevalent in smokers, although the difference did not reach statistical significance.