Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors

Author(s): Hansson PO, Sörbo J, Eriksson H

Abstract

Background: The recurrence rate after deep vein thrombosis (DVT) is high and the risk factors for recurrent thromboembolic events have only been investigated on a small scale.

Objectives: To estimate the cumulative incidence of recurrent venous thromboembolic events after a first or a second DVT and to identify possible risk factors for recurrent venous thromboembolism.

Methods: We prospectively followed up 738 consecutive patients with an objectively verified symptomatic DVT for 3.7 to 8.8 years. Medical records and death certificates for all patients were reviewed during follow-up and recurrent DVT and pulmonary embolism were registered.

Results: The 5-year cumulative incidence of recurrent venous thromboembolic events was 21.5% (95% confidence interval [CI], 17.7%-25.4%) after a first DVT and 27.9% (95% CI, 19.7%-36.1%) after a second DVT. The 5-year cumulative incidence of fatal pulmonary embolism was 2.6% (95% CI, 1.1%-4.1%) after a first DVT. Proximal DVT (relative risk [RR], 2.40; 95% CI, 1.48-3.88; P<.001), cancer (RR, 1.97; 95% CI, 1.20-3.23; P<.001), and history of a venous thromboembolism (RR, 1.71; 95% CI, 1.16-2.52; P<.01) predicted an independently increased risk of recurrent events in multivariate survival analysis. Postoperative DVT (RR, 0.27; 95% CI, 0.13-0.55; P<.001) and a long duration of oral anticoagulation therapy (RR, 0.95; 95% CI, 0.92-0.98; P<.01) involved a smaller risk of recurrent events. Sex, age, initial antithrombotic therapy, or immobilization did not affect the risk of a recurrent event.

Conclusions: The recurrence rate after a symptomatic DVT is high. Patients with proximal DVT, diagnosed cancer, short duration of oral anticoagulation therapy, or a history of thromboembolic events had a higher risk of recurrent events, while patients with postoperative DVT had a lower recurrence rate. This knowledge could help identify patients who might benefit most from prolonged prophylactic treatment in various risk situations.

Similar Articles

A prospective study of the incidence of deep-vein thrombosis within a defined urban population

Author(s): Nordström M, Lindblad B, Bergqvist D, Kjellström T

A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism

Author(s): Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, et al.

Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study

Author(s): Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, et al.

Age, an independent risk factor for thrombosis

Author(s): MahéI, Caulin C, Bergmann JF

Immobilization and the risk of venous thromboembolism

Author(s): Pottier P, Hardouin JB, Lejeune S, Jolliet P, Gillet B, et al.

Management of pulmonary embolism in a cardiology department

Author(s): OuldzeinH, Nourredine A, Cherradi R, Rahal N, Mechmeche R, et al.

Prolonged work- and computer-related seated immobility and risk of venous thromboembolism

Author(s): Healy B, Levin E, Perrin K, Weatherall M, Beasley R

Venous thromboembolism in Jamaican women: experience in a university hospital in Kingston

Author(s): Fletcher HM, Wharfe G, Williams NP, Pedican M, Brooks A, et al.

A prospective study of risk factors for pulmonary embolism in women

Author(s): Goldhaber SZ, Grodstein F, Stampfer MJ, Manson JE, Colditz GA, et al.

Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy

Author(s): Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, et al.

Epidemiology of acute deep vein thrombosis

Author(s): BulgerCM, Jacobs C, Patel NH

Hormonal contraception and risk of venous thromboembolism: national follow-up study

Author(s): Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C

Low-dose oral contraceptives and acquired resistance to activated protein C: a randomised cross-over study

Author(s): Rosing J, Middeldorp S, Curvers J, Christella M, Thomassen LG, et al.

Effects on coagulation of levonorgestrel- and desogestrel-containing low dose oral contraceptives: a cross-over study

Author(s): Middeldorp S, Meijers JC, van den Ende AE, van Enk A, Bouma BN, et al.

Impact of progestagens on activated protein C (APC) resistance among users of oral contraceptives

Author(s): Alhenc-Gelas M, Plu-Bureau G, Guillonneau S, Kirzin JM, Aiach M, et al.

Effect of four different oral contraceptives on various sex hormones and serum-binding globulins

Author(s): Wiegratz I, Kutschera E, Lee JH, Moore C, Mellinger U, et al.

[Upper limb deep venous thrombosis]

Author(s): Benhamou Y, Marie I, David N, Gbaguidi X, Cailleux N, et al.

Old and new risk factors for upper extremity deep venous thrombosis

Author(s): Blom JW, Doggen CJ, Osanto S, Rosendaal FR

Homocysteine and vascular disease

Author(s): Hankey GJ, Eikelboom JW

The long-term clinical course of acute deep venous thrombosis

Author(s): Prandoni P, Lensing AW, CogoA, Cuppini S, Villalta S, et al.

The duration of oral anticoagulant therapy after a second episode of venous thromboembolism

Author(s): Schulman S, Granqvist S, Holmström M, Carlsson A, Lindmarker P, et al.