Haematologica, Vol 92, Issue 2, 199-205 doi:10.3324/haematol.10516
Copyright © 2007 by Ferrata Storti Foundation
Paolo Prandoni ,
Franco Noventa ,
Angelo Ghirarduzzi ,
Vittorio Pengo ,
Enrico Bernardi ,
Raffaele Pesavento ,
Matteo Iotti ,
Daniela Tormene ,
Paolo Simioni ,
Antonio Pagnan
Copyright © 2007 by Ferrata Storti Foundation
Thrombosis |
The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients
From the Department of Medical and Surgical Sciences (PP, EB, PS, RP, DT, AP), Department of Clinical and Experimental Medicine, Group of Clinical Epidemiology (FN), and Department of Cardiothoracic and Vascular Sciences (VP), University of Padua, Padua; Department of Internal Medicine, Angiology Unit, Arcispedale Santa Maria Nuova, (AG, MI), Reggio Emilia, Italy
Correspondence: Paolo Prandoni, Department of Medical and Surgical Sciences, 2nd Chair of Internal Medicine, University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy. E-mail: paoloprandoni{at}tin.it
Background and Objectives: While it has long been recognized that patients with acute unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) have a higher risk of recurrent venous thromboembolism (VTE) than that of patients with secondary thrombosis, whether other clinical parameters can help predict the development of recurrent events is controversial. The aim of this investigation was to assess the rate of recurrent VTE after withdrawal of vitamin K antagonists, and to identify clinical parameters associated with a higher likelihood of recurrence.
Design and Methods: We followed, up to a maximum of 10 years, 1626 consecutive patients who had discontinued anticoagulation after a first episode of clinically symptomatic proximal DVT and/or PE. All patients with clinically suspected recurrent VTE underwent objective tests to confirm or rule out the clinical suspicion.
Results: After a median follow-up of 50 months, 373 patients (22.9%) had had recurrent episodes of VTE. The cumulative incidence of recurrent VTE was 11.0% (95% CI, 9.5–12.5) after 1 year, 19.6% (17.5–21.7) after 3 years, 29.1% (26.3–31.9) after 5 years, and 39.9% (35.4–44.4) after 10 years. The adjusted hazard ratio for recurrent VTE was 2.30 (95% CI, 1.82–2.90) in patients whose first VTE was unprovoked, 2.02 (1.52–2.69) in those with thrombophilia, 1.44 (1.03–2.03) in those presenting with primary DVT, 1.39 (1.08–1.80) for patients who received a shorter (up to 6 months) duration of anticoagulation, and 1.14 (1.06–1.12) for every 10-year increase of age. When the analysis was confined to patients with unprovoked VTE the results did not change.
Interpretation and Conclusions: Besides unprovoked presentation, other factors independently associated with a statistically significant increased risk of recurrent VTE are thrombophilia, clinical presentation with primary DVT, shorter duration of anticoagulation, and increasing age.
Key words: venous thrombosis, venous thromboembolism, deep vein thrombosis, pulmonary embolism, anticoagulation, thrombophilia, heparin, warfarin.
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