Risk of recurrent venous thromboembolism according to baseline risk factor profiles

Abstract

The optimal duration of anticoagulation for venous thromboembolism (VTE) is uncertain. In this prespecified analysis, we used data from 2 randomized trials, which compared once-daily rivaroxaban (20 mg or 10 mg) with aspirin (100 mg) or placebo for extended VTE treatment to estimate the risk of recurrence according to baseline risk factor profiles. Index VTE events were centrally classified as unprovoked, or provoked by major transient or persistent, or minor transient or persistent risk factors, and rates of recurrence at 1 year were calculated. A total of 2832 patients received rivaroxaban; 1131 received aspirin, and 590 received placebo. With unprovoked VTE, rates of recurrence in the 1173 patients given rivaroxaban, the 468 given aspirin, and the 243 given placebo were 2.0%, 5.9%, and 10.0%, respectively. There were no recurrences in patients with VTE provoked by major transient risk factors. With VTE provoked by minor persistent risk factors, recurrence rates in the 1184 patients given rivaroxaban, the 466 given aspirin, and the 248 given placebo were 2.4%, 4.5%, and 10.7%, respectively. For patients with minor transient risk factors, recurrence rates were 0.4% in the 268 patients given rivaroxaban, 4.2% in the 121 given aspirin, and 7.1% in the 56 given placebo. Recurrence rates in patients with VTE provoked by minor persistent or minor transient risk factors were not significantly lower than that with unprovoked VTE (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.56-1.16; and HR, 0.68; 95% CI, 0.32-1.30, respectively). Therefore, such patients may also benefit from extended anticoagulation therapy.

High incidence of venous thromboembolism recurrence in patients with sickle cell disease

“…Also, the concept of provocation may be more nuanced than in the past. A recent analysis that combined data from several clinical trials suggested that patients with VTE, associated with a transient minor or persistent minor provocation, had a recurrent VTE as often as those without obvious provocation . The SCD itself likely represents a persistent provoking condition.…”

Rivaroxaban or vitamin-K antagonists following early endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis

“…[17][18][19][20] Anticoagulation therapy remains the cornerstone for patients with DVT. Recently, direct oral anticoagulants (DOAC), including rivaroxaban, have replaced vitamin K-antagonists (VKA) as first-line therapy in most DVT patients, due to reduced risk of major bleeding [21][22][23][24] and increased patient comfort. DOACs may become an alternative to low-molecular-weight heparins (LMWH) in patients with cancerassociated thrombosis and low risk of bleeding.…”

Substantial recurrence risk after venous thromboembolism provoked by minor risk factors

“…Moreover, to assess whether the current classification of provoking factors as minor transient or persistent is clinically useful, more information is needed on the risk of recurrence in these categories. In a recent study published in Blood Advances , Prins et al . estimated the 1‐year cumulative incidence of VTE recurrence according to four categories of provoking factors.…”

“…Moreover, to assess whether the current classification of provoking factors as minor transient or persistent is clinically useful, more information is needed on the risk of recurrence in these categories. In a recent study published in Blood Advances [3], Prins et al estimated the 1-year cumulative incidence of VTE recurrence according to four categories of provoking factors. They used data from the EINSTEIN-EXTENSION and EINSTEIN CHOICE studies, which are randomized controlled trials comparing the efficacy and safety of rivaroxaban with placebo, or rivaroxaban with aspirin, for the extended treatment of VTE.…”