Occurrence and predictors of recurrence after a first episode of acute venous thromboembolism: population-based Worcester Venous Thromboembolism Study
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Venous thromboembolism (VTE) has multiple risk factors and tends to recur. Despite the benefits of anticoagulation, the prevalence of, and case-fatality rate associated with, recurrent VTE remains a concern after an acute episode; it is particularly high during the acute treatment phase. We sought to quantify the magnitude, identify predictors, and develop risk score calculator of recurrence within 3 years after first-time VTE. This was a population-based surveillance study among residents of central Massachusetts (MA), USA, diagnosed with an acute first-time pulmonary embolism and/or lower-extremity deep vein thrombosis from 1999 to 2009 in hospital and ambulatory settings in all 12 central MA hospitals. Medical records were reviewed and validated. The 2989 study patients were followed for 5836 person-years [mean follow-up 23.4 (median 30) months]. Mean age was 64.3 years, 44 % were men, and 94 % were white. The cumulative incidence rate of recurrent VTE within 3 years after an index VTE was 15 % overall, and 25, 13, and 13 % among patients with active cancer, provoked, or unprovoked VTE, respectively. Multivariable regression indicated that active cancer, varicose vein stripping, and inferior vena cava filter placement were independent predictors of recurrence during both 3-month and 3-year follow-up. A risk score calculator was developed based on the 3-month prognostic model. In conclusion, the rate of VTE recurrence over 3 years of follow-up remained high. The risk score calculator may assist clinicians at the index encounter in determining the frequency of clinical surveillance and appropriate outpatient treatment of VTE during the acute treatment phase.
KeywordsVenous thrombosis Pulmonary embolism Recurrence Predictors Risk assessment Epidemiology
National Heart, Lung, and Blood Institute (R01-HL70283), and National Institute of Aging (R01AG031083).
Gordon FitzGerald, PhD (Center for Outcomes Research), Arlene Ash, PhD, Catarina Kiefe, MD, PhD, David Hoaglin, PhD, and Allison Rosen, MD, ScD (Department of Quantitative Health Sciences) and Joel Gore, MD (Department of Medicine) at UMass Medical School for helpful comments. Editorial support for the final version of the manuscript was provided by Sophie Rushton-Smith, PhD (Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA).
Compliance with ethical standards
Conflict of interest
Professor Anderson received research grants from Sanofi and The Medicines Company; he has served as a consultant to GlaxoSmithKline and Takeda Oncology on the design of outcomes studies. Dr. Cohen reports grants and personal fees from Bayer, Boehringer-Ingelheim, BMS, Daiichi, GSK, Johnson and Johnson, Pfizer, Portola, Sanofi and XO1, outside the submitted work. All other authors declare that they have no conflict of interest.
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