Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism

M. J. Kovacs, S. R. Kahn, P. S. Wells, D. A. Anderson, I. Chagnon, G. Le Gal, S. Solymoss, M. Crowther, A. Perrier, T. Ramsay, M. T. Betancourt, Richard H White, L. Vickars, M. A. Rodger

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). Objectives: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. Patients/Methods: Six hundred and forty-six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5-7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. Results: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow-up, there were 91 recurrent VTE events (9.5% annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7%, 16.5% and 17.7%, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95% confidence interval 1.2-3.7). Conclusions: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.

Original languageEnglish (US)
Pages (from-to)1926-1932
Number of pages7
JournalJournal of Thrombosis and Haemostasis
Volume8
Issue number9
DOIs
StatePublished - Sep 2010

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Venous Thromboembolism
Pulmonary Embolism
Venous Thrombosis
Anticoagulants
Recurrence
Multicenter Studies
Heparin
Cohort Studies
Confidence Intervals

Keywords

  • DVT
  • Idiopathic
  • Outcomes
  • PE
  • Recurrence
  • Treatment

ASJC Scopus subject areas

  • Hematology

Cite this

Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism. / Kovacs, M. J.; Kahn, S. R.; Wells, P. S.; Anderson, D. A.; Chagnon, I.; Le Gal, G.; Solymoss, S.; Crowther, M.; Perrier, A.; Ramsay, T.; Betancourt, M. T.; White, Richard H; Vickars, L.; Rodger, M. A.

In: Journal of Thrombosis and Haemostasis, Vol. 8, No. 9, 09.2010, p. 1926-1932.

Research output: Contribution to journalArticle

Kovacs, MJ, Kahn, SR, Wells, PS, Anderson, DA, Chagnon, I, Le Gal, G, Solymoss, S, Crowther, M, Perrier, A, Ramsay, T, Betancourt, MT, White, RH, Vickars, L & Rodger, MA 2010, 'Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism', Journal of Thrombosis and Haemostasis, vol. 8, no. 9, pp. 1926-1932. https://doi.org/10.1111/j.1538-7836.2010.03958.x
Kovacs, M. J. ; Kahn, S. R. ; Wells, P. S. ; Anderson, D. A. ; Chagnon, I. ; Le Gal, G. ; Solymoss, S. ; Crowther, M. ; Perrier, A. ; Ramsay, T. ; Betancourt, M. T. ; White, Richard H ; Vickars, L. ; Rodger, M. A. / Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism. In: Journal of Thrombosis and Haemostasis. 2010 ; Vol. 8, No. 9. pp. 1926-1932.
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abstract = "Background: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). Objectives: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. Patients/Methods: Six hundred and forty-six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5-7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. Results: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow-up, there were 91 recurrent VTE events (9.5{\%} annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7{\%}, 16.5{\%} and 17.7{\%}, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95{\%} confidence interval 1.2-3.7). Conclusions: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.",
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T1 - Patients with a first symptomatic unprovoked deep vein thrombosis are at higher risk of recurrent venous thromboembolism than patients with a first unprovoked pulmonary embolism

AU - Kovacs, M. J.

AU - Kahn, S. R.

AU - Wells, P. S.

AU - Anderson, D. A.

AU - Chagnon, I.

AU - Le Gal, G.

AU - Solymoss, S.

AU - Crowther, M.

AU - Perrier, A.

AU - Ramsay, T.

AU - Betancourt, M. T.

AU - White, Richard H

AU - Vickars, L.

AU - Rodger, M. A.

PY - 2010/9

Y1 - 2010/9

N2 - Background: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). Objectives: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. Patients/Methods: Six hundred and forty-six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5-7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. Results: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow-up, there were 91 recurrent VTE events (9.5% annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7%, 16.5% and 17.7%, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95% confidence interval 1.2-3.7). Conclusions: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.

AB - Background: Previous studies are mixed as to whether patients with unprovoked pulmonary embolism (PE) have a higher rate of venous thromboembolism (VTE) recurrence after anticoagulation is discontinued than patients with unprovoked deep vein thrombosis (DVT). Objectives: To determine whether patients with unprovoked PE have a higher rate of VTE recurrence than patients with unprovoked DVT in a prospective multicenter cohort study. Patients/Methods: Six hundred and forty-six patients with a first episode of symptomatic unprovoked VTE were treated with heparin and subsequent oral anticoagulation for 5-7 months, and were followed every 6 months for recurrent VTE after their anticoagulant therapy was discontinued. Results: Of 646 patients, 194 had isolated PE, 339 had isolated DVT, and 113 had both DVT and PE. After a mean of 18 months of follow-up, there were 91 recurrent VTE events (9.5% annualized risk of recurrent VTE in the total population). The crude recurrent VTE rate for the isolated PE, isolated DVT and DVT and PE groups were 7.7%, 16.5% and 17.7%, respectively. The relative risk of recurrent VTE for isolated DVT vs. isolated PE was 2.1 (95% confidence interval 1.2-3.7). Conclusions: This study has demonstrated that patients with a first episode of unprovoked isolated DVT are 2.1 times more likely to have a recurrent VTE episode than patients with a first episode of unprovoked isolated PE. These findings need to be considered when determining the optimal duration of anticoagulant therapy for patients with unprovoked VTE.

KW - DVT

KW - Idiopathic

KW - Outcomes

KW - PE

KW - Recurrence

KW - Treatment

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