Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?

Abstract

Recurrent venous thromboembolism (VTE, or deep vein thrombosis and pulmonary embolism) is associated with mortality and long-term morbidity. The circumstances in which an index VTE event occurred are crucial when personalized VTE recurrence risk is assessed. Patients who experience a VTE event in the setting of a transient major risk factor (such as surgery associated with general anesthesia for >30 minutes) are predicted to have a low VTE recurrence risk following discontinuation of anticoagulation, and limited-duration anticoagulation is generally recommended. In contrast, those patients whose VTE event occurred in the absence of risk factors or who have persistent risk factors have a higher VTE recurrence risk. Here, we review the literature surrounding VTE recurrence risk in a range of clinical conditions. We describe gender-specific risks, including VTE recurrence risk following hormone- and pregnancy-associated VTE events. Finally, we discuss how the competing impacts of VTE recurrence and bleeding have shaped international guideline recommendations.

The utility of hereditary thrombophilia testing among patients with unprovoked venous thromboembolism

“…This relatively high VTE recurrence risk in this cohort (23% at median follow-up of 55 months) is comparable to that found in other studies investigating unprovoked VTE. 12 This further underscores the rationale for indefinite AC among patients with unprovoked VTE. At our centers, patients with unprovoked VTE are generally placed on indefinite AC.…”

“…The higher recurrence risk associated with PE (in comparison with DVT) has been noted in prior studies. 12 This study has a number of limitations largely as a result of its retrospective nature. The inclusion of only those patients who received F I G U R E 1 A Kaplan-Meier curve demonstrating recurrent VTE free survival over time for both groups is shown above.…”

“…The primary determinants of VTE recurrence risk are the clinical circumstances surrounding the initial VTE (ie, whether it was provoked by a transient factor or unprovoked). 12 Any additional risk imparted by HT is likely marginal in comparison with the implicit risk imposed by the unprovoked nature of a VTE and thus is unlikely to modify it significantly. The only factor associated with increased recurrence risk on multivariable analysis was a clinical one, namely the presence of PE (as opposed to DVT alone).…”

Pulmonary embolism management in the emergency department: part 2

“…VTE recurrence following a provoked clot is approximately 3% per patient-year after stopping anticoagulant therapy 54. This risk is higher (at least 8%) in patient groups such as those with cancer or antiphospholipid syndrome and in those with no provoking cause for their PE 55…”

Risk factors, diagnosis and management of venous thromboembolic disease in pregnancy

“…Women with a personal VTE history have a high recurrence risk during pregnancy. Women at highest risk are those with a history of unprovoked or hormone-provoked VTE [14]. In a recent pooled analysis of four cohort studies, antenatal VTE recurrence rates during pregnancy without prophylaxis were reported to be 1.1% (95% CI 0.2-5.8%), 6.4% (95% CI 3.9-10.4%), and 3.6% (95% CI 1.4-8.9%) for provoked (non-hormonal), oestrogen-related, and unprovoked VTE, respectively [14].…”