High rate of unprovoked recurrent venous thrombosis is associated with high thrombin‐generating potential in a prospective cohort study

• Published in: Journal of thrombosis and haemostasis 2008-10, Vol.6 (10), p.1720-1725
• Main Authors: BESSER, M., BAGLIN, C., LUDDINGTON, R., VAN HYLCKAMA VLIEG, A., BAGLIN, T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prospective Studies; Recurrence; Thrombin - analysis; Thrombin - biosynthesis; thrombin generation; unprovoked; venous thrombosis; Venous Thrombosis - diagnosis; Venous Thrombosis - etiology
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/j.1538-7836.2008.03117.x

Objective: To determine the predictive value of measurement of parameters of thrombin generation for unprovoked recurrent venous thrombosis. Methods: Measurements were made of thrombin generation in a prospective cohort study of 188 patients with a first episode of venous thrombosis that was unprovoked, or provoked by a non‐surgical trigger. Results: The endogenous thrombin potential (ETP) was the only parameter associated with unprovoked recurrent thrombosis in a multivariate model [hazard ratio (HR) 1.3 per 100 nmol L min−1 increase, 95% confidence interval (CI) 1.0–1.6]. Patients with a high ETP had a significantly higher rate of unprovoked recurrence than those with a low ETP (HR 2.9, 95% CI  1.3–6.6, cumulative recurrence at 4 years 27% vs. 11%). Patients with an unprovoked first event had a significantly higher rate of unprovoked recurrence than those with a provoking factor (HR 2.7, 95% CI  1.2–6.1), and in these patients there was a significantly higher rate of unprovoked recurrence in association with a high ETP (HR 4.0, 95% CI  1.3–11.8). After adjustment for D‐dimer, thrombophilia, sex, and whether or not the first event was unprovoked, a high ETP remained a significant predictor of recurrence (HR 2.6, 95% CI  1.2–6.0). Conclusions: This study demonstrates a high rate of unprovoked recurrent venous thrombosis in patients presenting with a first episode of venous thrombosis and a high ETP.