Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: A systematic review

Alfonso Iorio, Clive Kearon, Esmeralda Filippucci, Maura Marcucci, Ana Macura, Vittorio Pengo, Sergio Siragusa, Gualtiero Palareti

Research output: Contribution to journalArticle

Abstract

Background: We aimed to determine the risk of recurrence for symptomatic venous thromboembolism (VTE) provoked by different transient risk factors. Data Sources: MEDLINE, EMBASE, and Cochrane Collaboration Registry of Randomized Trials databases were searched. Study Selection: Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified. Data Extraction: Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted. Data Synthesis: Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTEwas 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months. Conclusions: The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment.

Original languageEnglish
Pages (from-to)1710-1716
Number of pages7
JournalArchives of Internal Medicine
Volume170
Issue number19
DOIs
Publication statusPublished - Oct 25 2010

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

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