The long‐term recurrence risk of patients with unprovoked venous thromboembolism: an observational cohort study

• Published in: Journal of thrombosis and haemostasis 2016-12, Vol.14 (12), p.2402-2409
• Main Authors: Kyrle, P. A., Kammer, M., Eischer, L., Weltermann, A., Minar, E., Hirschl, M., Heinze, G., Eichinger, S.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Austria; deep vein thrombosis; Embolisms; Female; Fibrinolytic Agents - therapeutic use; Health risk assessment; Humans; Male; Middle Aged; observational study; Patients; Proportional Hazards Models; Prospective Studies; pulmonary embolism; Pulmonary Embolism - blood; Pulmonary Embolism - complications; Pulmonary Embolism - drug therapy; Recurrence; relapse; Sex Factors; Thromboembolism; Thrombophilia - complications; Thrombosis; Time Factors; venous thromboembolism; Venous Thromboembolism - blood; Venous Thromboembolism - complications; Venous Thromboembolism - drug therapy; Venous Thrombosis - blood; Venous Thrombosis - complications; Venous Thrombosis - drug therapy
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13524

Essentials Long‐term recurrence risk of venous thromboembolism (VTE) is uncertain. We performed a prospective cohort study of 839 patients with first unprovoked VTE. VTE recurrence risk is high, particularly in men with proximal thrombosis or pulmonary embolism. Sex and VTE site determine the recurrence risk and should be considered for patient counseling. Summary Background The long‐term recurrence risk (ltRR) of venous thromboembolism (VTE) is uncertain. Objective To assess the ltRR of patients with first unprovoked VTE. Patients/methods Patients were classified into three categories: distal deep vein thrombosis (DVT), proximal DVT or pulmonary embolism (PE), that is, PE associated with DVT or isolated PE. Patients with major thrombophilia or antithrombotic therapy were excluded. The endpoint was recurrent symptomatic VTE. Results A total of 839 patients were followed for a median of 7.7 years. VTE recurred in 263 patients (31%). After 10 and 20 years, the cumulative ltRR was 32% (95% confidence interval [CI], 29–36) and 44% (95% CI, 38–49) with 3.9 (95% CI, 3.3–4.6) and 3.3 (95% CI, 2.7–4.0) events per 100 patient‐years, respectively. The adjusted hazard ratio was 2.1 (95% CI, 1.4–3.2) and 2.1 (95% CI, 1.4–3.2) for patients with proximal DVT or PE compared with patients with distal DVT and was 2.1 (95% CI, 1.6–2.9) for men compared with women. At 10 years, 4.7 (95% CI, 3.8–5.8) events per 100 patient‐years occurred in men with proximal DVT or PE, 2.4 (95% CI, 1.2–4.4) in men with distal DVT, 1.9 (95% CI, 1.2–2.8) in women with proximal DVT or PE and 0.9 (95% CI, 0.2–1.9) in women with distal DVT. Conclusion The ltRR of patients with first unprovoked VTE is high and dependent upon sex and VTE site.