Abstract
Patients with unprovoked deep-vein thrombosis (DVT) of the leg or pulmonary embolism (PE) have a high recurrence risk. How often these recurrences are provoked by a temporary risk condition is unknown. In a cohort of patients with unprovoked venous thromboembolism (VTE), we evaluated the clinical circumstances of recurrence. We studied patients with DVT of the leg and/or PE. End point was recurrence of objectively verified symptomatic VTE. Provoked recurrence was defined according to guidance criteria. 1188 patients were followed for a median of 8.9 years after withdrawal of oral anticoagulants. 312 patients had recurrent VTE, which was provoked in 42 (13%). Recurrence was related to a major risk factor in 19, to a minor risk factor in 22, and to a persistent risk factor in one patient(s). 14 recurrences occurred after major surgery and 5 during hospitalization. Ten recurrences occurred after minor surgery, eight after trauma and three during female hormone intake. Four recurrences occurred during heparin prophylaxis. The incidence of provoked VTE recurrence appears to be low. VTE can recur when prevention is stopped or even during thromboprophylaxis. Surgery and trauma are frequent risk factors.
Highlights
Highlights Patients with unprovoked venous thromboembolism (VTE) have a high recurrence risk. 42 of 1188 patients with a first unprovoked VTE had a provoked recurrence. Surgery and trauma were the most prevalent risk factors.Venous thromboembolism (VTE), which encompasses deepvein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially fatal disease
A history of VTE is regarded as a major risk factor for VTE recurrence, when a patient is exposed to a temporary risk condition
548 patients were censored during follow-up for the following reasons: 253 (21%) were started on long-term antithrombotic treatment for reasons other than VTE [aspirin in 194 (16%) patients, oral anticoagulants in 59 (5%) patients]; 72 (6%) became pregnant and received thromboprophylaxis with a low-molecular-weight heparin; 31 (3%) died for reasons other than recurrent PE; 51 (4%) patients received a diagnosis of cancer. 48 (4%) patients withdrew their consent. 93 (8%) patients were lost-to-follow-up
Summary
Venous thromboembolism (VTE), which encompasses deepvein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially fatal disease. VTE is a preventable disease as pharmacologic thromboprophylaxis is highly effective. A history of VTE is regarded as a major risk factor for VTE recurrence, when a patient is exposed to a temporary risk condition. Under these circumstances, guidelines recommend standard pharmacological thromboprophylaxis for surgical as well as for non-surgical patients [3, 4]. Guidelines recommend standard pharmacological thromboprophylaxis for surgical as well as for non-surgical patients [3, 4] Whether these measures are effective in patients with a previous VTE compared with patients with no history of VTE is unknown
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