Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors

SummaryEstablished risk factors, including deficiencies of protein C, protein S or antithrombin and the factor V Leiden and prothrombin mutation, are present in about one third of unselected patients with venous thromboembolism. In addition to these inherited thrombophilic defects, elevated plasma levels of factor VIIIc have been suggested to be important in the pathogenesis of (recurrent) venous thromboembolism. The objective of this study was to assess the relevance of factor VIIIc plasma concentration in consecutive patients with venous thromboembolism.We studied the prevalence of elevated plasma levels of factor VIIIc in 65 patients with a proven single episode and in 60 matched patients with documented recurrent venous thromboembolism. The reference group consisted of 60 ageand sex-matched patients who were referred for suspected venous thromboembolism, which was refuted by objective testing and longterm clinical follow-up. To minimalize the influence of the acute phase, blood was obtained at least 6 months after the thromboembolic event and results were adjusted for fibrinogen and C-reactive protein. Factor VIIIc was re-determined several years after the first measurement in a subset of patients to evaluate the variability over time. To study a possible genetic cause, a family study was done.In the control, single and recurrent episode group, the prevalences of plasma levels of factor VIIIc above 175 IU/dl (90th percentile of controls) were 10% (95% CI: 4 to 21%), 19% (95% CI: 10 to 30%) and 33% (95% CI: 22 to 47%), respectively. For each 10 IU/dl increment of factor VIIIc, the risk for a single and recurrent episode of venous thrombosis increased by 10% (95% CI: 0.9 to 21%) and 24% (95% CI: 11 to 38%), respectively. Both low and high plasma levels of factor VIIIc were consistent over time (R = 0.80, p = 0.01). A family study indicated a high concordance for elevated factor VIIIc plasma concentrations among first degree family members. Adjustment for fibrinogen, C-reactive protein and known thrombophilic risk factors did not change the observed association of elevated factor VIIIc with thrombosis.Elevated plasma levels of factor VIIIc are a significant, prevalent, independent and dose-dependent risk factor for venous thromboembolism. It also predisposes to recurrent venous thromboembolism.

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Sex-specific risk factors for recurrent venous thromboembolism

Thrombosis Research ◽

10.1016/j.thromres.2011.10.026 ◽

2012 ◽

Vol 130 (1) ◽

pp. 16-20 ◽

Cited By ~ 26

Author(s):

Valérie Olié ◽

Tienan Zhu ◽

Isabelle Martinez ◽

Pierre-Yves Scarabin ◽

Joseph Emmerich

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Specific Risk ◽

Recurrent Venous Thromboembolism

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

Blood Advances ◽

10.1182/bloodadvances.2020002268 ◽

2020 ◽

Vol 4 (21) ◽

pp. 5595-5606

Author(s):

Fionnuala Ní Áinle ◽

Barry Kevane

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Recurrence Risk ◽

Vein Thrombosis ◽

Recurrent Venous Thromboembolism ◽

Clinical Conditions ◽

Deep Vein

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.

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Clinical Risk Factors and Timing of Recurrent Venous Thromboembolism During the Initial 3 Months of Anticoagulant Therapy

Archives of Internal Medicine ◽

10.1001/archinte.160.22.3431 ◽

2000 ◽

Vol 160 (22) ◽

pp. 3431 ◽

Cited By ~ 158

Author(s):

James D. Douketis ◽

Gary A. Foster ◽

Mark A. Crowther ◽

Martin H. Prins ◽

Jeffrey S. Ginsberg

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Anticoagulant Therapy ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Recurrent Venous Thromboembolism

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Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: Results from the OPTIMEV study

Thrombosis and Haemostasis ◽

10.1160/th09-01-0053 ◽

2009 ◽

Vol 102 (09) ◽

pp. 493-500 ◽

Cited By ~ 67

Author(s):

Marie-Antoinette Sevestre-Pietri ◽

Jean-Luc Bosson ◽

Jean-Pieere Laroche ◽

Marc Righini ◽

Dominique Brisot ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Major Bleeding ◽

Lower Limbs ◽

Early Outcome ◽

Vein Thrombosis ◽

Recurrent Venous Thromboembolism ◽

Deep Vein ◽

Active Cancer

SummaryThere is a lack of consensus on the value of detecting and treating symptomatic isolated distal deep-vein thrombosis (DVT) of the lower limbs. In our study, we compared the risk factors and outcomes in patients with isolated symptomatic distal DVT with those with proximal symptomatic DVT. We analysed the data of patients with objectively confirmed symptomatic isolated DVT enrolled in the national (France), multicenter, prospective OPTIMEV study.This sub-study outcomes were recurrent venous thromboembolism, major bleeding and death at three months. Among the 6141 patients with suspicion of isolated DVT included between November 2004 and January 2006, DVT was confirmed in 1643 patients (26.8%). Isolated distal DVT was more frequent than proximal DVT (56.8% vs. 43.2%, respectively; p=0.01). Isolated distal DVT was significantly more often associated with transient risk factors (recent surgery, recent plaster immobilisation, recent travel), whereas proximal DVT was significantly more associated with more chronic states (active cancer, congestive heart failure or respiratory insufficiency, age >75 years). Most patients (96.8%) with isolated distal DVT received anticoagulant therapies.There was no difference in the percentage of recurrent venous thromboembolism and major bleeding in patients with proximal DVT and isolated distal DVT. However, the mortality rate was significantly higher (p<0.01) in patients with proximal DVT (8.0%) than in those with isolated distal DVT (4.4%). Symptomatic isolated distal DVT differs from symptomatic proximal DVT both in terms of risk factors and clinical outcome. Whether these differences should influence the clinical management of these two events remains to be determined.

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Long-term strategies in patients with unprovoked venous thromboembolism

Phlebologie ◽

10.12687/phleb2372-5-2017 ◽

2017 ◽

Vol 46 (05) ◽

pp. 288-291

Author(s):

P. Prandoni

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Low Dose ◽

Risk Profile ◽

Substantial Proportion ◽

First Episode ◽

Vein Thrombosis ◽

Recurrent Venous Thromboembolism ◽

D Dimer

SummaryOnce anticoagulation is stopped, the risk of recurrent venous thromboembolism (VTE) over years approaches 40 % of all patients with a first episode of VTE. The risk is twice as high in patients with unprovoked VTE than in those with minor (either transient or persistent) risk factors of thrombosis. Although the latest international guidelines suggest indefinite anticoagulation for most patients with a first episode of unprovoked VTE, strategies that incorporate the assessment of residual vein thrombosis and D-dimer have the potential to identify a substantial proportion of subjects in whom anticoagulation can be safely discontinued. For those patients in whom anticoagulation cannot be discontinued, new opportunities are offered by the availability of low-dose anti-Xa compounds, which have been found to possess an extremely favorable benefit/risk profile.

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