The Risk of Recurrent Venous Thromboembolism in Men and Women

Kyrle, Paul A.; Minar, Erich; Bialonczyk, Christine; Hirschl, Mirko; Weltermann, Ansgar; Eichinger, Sabine

doi:10.1056/nejmoa032959

Cited by 423 publications

(326 citation statements)

References 23 publications

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“…study participants and setting Consecutive unselected patients at 44 secondary and tertiary care centres in seven countries (see supplementary appendix) were asked to participate if they had a first episode of major, symptomatic, objectively proved unprovoked VTE 5-12 months before enrolment (referred to as the index VTE). Index VTE was defined as unprovoked, in line with other studies, [18][19][20] in the absence of the following major VTE provoking factors: leg fracture or lower extremity plaster cast, immobilisation for more than three days, major surgery in the three months before the index VTE event, and no diagnosis of a malignancy in the past five years (with the exception of localised skin malignancy). Patients with malignancy arising after diagnosis of index VTE but before enrolment were not eligible for inclusion.…”

Section: Methodsmentioning

confidence: 85%

Validating the HERDOO2 Rule to Guide Treatment Duration for Women With Unprovoked Venous Thrombosis: Multinational Prospective Cohort Management Study

Rodger¹,

Gal²,

Anderson³

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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ObjeCtiveTo prospectively validate the HERDOO2 rule (Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years), which states that women with none or one of the criteria can safely discontinue anticoagulants after short term treatment. DesignProspective cohort management study. setting 44 secondary or tertiary care centres in seven countries. PartiCiPantsOf 3155 consecutive eligible participants with a first unprovoked venous thromboembolism (VTE, proximal leg deep vein thrombosis or pulmonary embolism) who completed 5-12 months of short term anticoagulant treatment, 370 declined to participate, leaving 2785 enrolled participants. 2.3% were lost to follow-up.interventiOns Women with none or one of the HERDOO2 criteria were classified as at low risk of recurrent VTE and discontinued anticoagulants (intervention arm), whereas anticoagulant management for high risk women (≥2 HERDOO2 criteria) and men was left to the discretion of the clinicians and patients (observation arm). Main OutCOMe MeasureRecurrent symptomatic VTE (independently and blindly adjudicated) over one year of follow-up. resultsOf 1213 women, 631 (51.3%) were classified as low risk and 591 discontinued oral anticoagulant treatment. In the primary analysis, 17 low risk women who discontinued anticoagulants developed recurrent VTE during 564 patient years of follow-up (3.0% per patient year, 95% confidence interval 1.8% to 4.8%). In 323 high risk women and men who discontinued anticoagulants, 25 had VTE during 309 patient years of follow-up (8.1%, 5.2% to 11.9%), whereas in 1802 high risk women and men who continued anticoagulants 28 had recurrent VTE during 1758 patient years of follow-up (1.6%, 1.1% to 2.3%). COnClusiOnsWomen with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment.trial registratiOn clinicaltrials.gov NCT00967304.

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Section: Methodsmentioning

confidence: 85%

Validating the HERDOO2 Rule to Guide Treatment Duration for Women With Unprovoked Venous Thrombosis: Multinational Prospective Cohort Management Study

Rodger¹,

Gal²,

Anderson³

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…Similar data were obtained in a study conducted on patients with a first event of DVT and PE; a trend toward a lower risk of recurrence after discontinuation of oral contraceptive was observed compared with subjects who had not taken estrogens, although this result was not confirmed for postmenopausal hormones. 12 One limitation of our study is that we included patients with incomplete thrombophilia evaluation. In fact, because of a relatively high percentage of subjects whose thrombophilic screening was not repeated after anticoagulation interruption, a decision was made to only consider clear prothrombotic abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Venous Thrombotic Recurrence After Cerebral Venous Thrombosis

Palazzo

Agius

Ingrand

et al. 2017

Stroke

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Background and Purpose-After cerebral venous thrombosis (CVT), the risk of venous thrombotic events was estimated at 2% to 3% for a new CVT and 3% to 8% for extracranial events. However, because of the paucity of prospective studies, the clinical course of CVT is still largely unknown. We aimed to prospectively evaluate the rate of thrombosis recurrence in a cohort of CVT patients with a long-term follow-up and to detect predisposing factors for recurrence. Methods-Consecutive CVT patients with complete clinical, radiological, biological, and genetic data were systematically followed up. New venous thrombotic events were detected after hospital readmission and imaging confirmation. Results-One-hundred eighty-seven patients (mean age 45±18 years, 67% women) with angiographically confirmed CVT were included. Cause was found in 73% of patients. Coagulation abnormality and JAK2 gene mutation were detected in 20% and 9%, respectively. Median follow-up length was 73 months (range 1-247 months). Mean duration of the oral anticoagulant treatment was 14 months. Mortality rate was 2.5% per year, with 2% in-hospital mortality. During follow-up, CVT reoccurred in 6 patients, whereas 19 subjects had a symptomatic extracranial venous thrombotic event, with cumulative venous thrombotic recurrence rates of 3% at 1 year, 8% at 2 years, 12% at 5 years, and 18% at 10 years. A previous venous thrombotic event (hazard ratio, 2.8; P=0.018), presence of cancer or malignant hemopathies (hazard ratio, 3.2; P=0.039), and unknown CVT causes (hazard ratio, 2.81; P=0.024) were independently associated with recurrence. Conclusions-In our cohort of CVT patients followed on average for >6 years, subjects with a previous venous thrombotic event, cancer/malignant hemopathies, and unknown CVT causes were found to be at higher risk of recurrence.

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“…However, 23 of 34 (68%) patients were women. When our trial was initiated, the higher risk of recurrence in men as compared with women was unknown, and we did not stratify our study population according to sex [14]. The larger proportion of women could therefore have resulted in an overall lower recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

6 versus 30 months anticoagulation for recurrent venous thrombosis in patients with high factor VIII

et al. 2008

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The Risk of Recurrent Venous Thromboembolism in Men and Women

Abstract: The risk of recurrent venous thromboembolism is higher among men than women.

Cited by 423 publications

References 23 publications

Validating the HERDOO2 Rule to Guide Treatment Duration for Women With Unprovoked Venous Thrombosis: Multinational Prospective Cohort Management Study

Validating the HERDOO2 Rule to Guide Treatment Duration for Women With Unprovoked Venous Thrombosis: Multinational Prospective Cohort Management Study

Venous Thrombotic Recurrence After Cerebral Venous Thrombosis

6 versus 30 months anticoagulation for recurrent venous thrombosis in patients with high factor VIII

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