Recurrent venous thromboembolism after surgery-provoked versus unprovoked thromboembolism

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Abstract

Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan-Meier cumulative incidence of recurrent VTE was 14.7 (95%CI: 14.2-15.1) in the matched unprovoked VTE group vs. 7.6% (CI: 7.0-8.2) in 11 797 patients with surgery-provoked VTE (P <0.001). The overall risk reduction was 48%, which ranged from 64% lower risk (P <0.001) after coronary bypass surgery to 25% lower risk (P =0.06) after disc surgery. The risk of recurrent VTE 1-5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41-0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8-1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50% lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations.

Original languageEnglish (US)
Pages (from-to)987-997
Number of pages11
JournalJournal of Thrombosis and Haemostasis
Volume8
Issue number5
DOIs
StatePublished - 2010

Fingerprint

Thromboembolism
Venous Thromboembolism
Incidence
Hospital Departments

Keywords

  • Epidemiology
  • Outcomes
  • Provoked
  • Recurrent
  • Surgery
  • Unprovoked
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

@article{0473479deda64976988ee19afaace486,
title = "Recurrent venous thromboembolism after surgery-provoked versus unprovoked thromboembolism",
abstract = "Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan-Meier cumulative incidence of recurrent VTE was 14.7 (95{\%}CI: 14.2-15.1) in the matched unprovoked VTE group vs. 7.6{\%} (CI: 7.0-8.2) in 11 797 patients with surgery-provoked VTE (P <0.001). The overall risk reduction was 48{\%}, which ranged from 64{\%} lower risk (P <0.001) after coronary bypass surgery to 25{\%} lower risk (P =0.06) after disc surgery. The risk of recurrent VTE 1-5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41-0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8-1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50{\%} lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations.",
keywords = "Epidemiology, Outcomes, Provoked, Recurrent, Surgery, Unprovoked, Venous thromboembolism",
author = "White, {Richard H} and Susan Murin and Theodore Wun and B. Danielsen",
year = "2010",
doi = "10.1111/j.1538-7836.2010.03798.x",
language = "English (US)",
volume = "8",
pages = "987--997",
journal = "Journal of Thrombosis and Haemostasis",
issn = "1538-7933",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Recurrent venous thromboembolism after surgery-provoked versus unprovoked thromboembolism

AU - White, Richard H

AU - Murin, Susan

AU - Wun, Theodore

AU - Danielsen, B.

PY - 2010

Y1 - 2010

N2 - Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan-Meier cumulative incidence of recurrent VTE was 14.7 (95%CI: 14.2-15.1) in the matched unprovoked VTE group vs. 7.6% (CI: 7.0-8.2) in 11 797 patients with surgery-provoked VTE (P <0.001). The overall risk reduction was 48%, which ranged from 64% lower risk (P <0.001) after coronary bypass surgery to 25% lower risk (P =0.06) after disc surgery. The risk of recurrent VTE 1-5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41-0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8-1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50% lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations.

AB - Background: The incidence of recurrent venous thromboembolism (VTE) varies depending on the nature of the initial provoking risk factor(s). Objectives: To compare the incidence and time course of recurrent VTE after unprovoked VTE vs. VTE provoked by nine different types of surgery. Methods: Retrospective analysis of linked California hospital and emergency department discharge records. Between 1997 and 2007, all surgery-provoked VTE cases had a first-time VTE event diagnosed within 60 days after undergoing a major operation. The incidence of recurrent VTE was compared during specified follow-up periods by matching each surgery-provoked case with three unprovoked cases based on age, race, gender, VTE event, calendar year and co-morbidity. Results: The 4-year Kaplan-Meier cumulative incidence of recurrent VTE was 14.7 (95%CI: 14.2-15.1) in the matched unprovoked VTE group vs. 7.6% (CI: 7.0-8.2) in 11 797 patients with surgery-provoked VTE (P <0.001). The overall risk reduction was 48%, which ranged from 64% lower risk (P <0.001) after coronary bypass surgery to 25% lower risk (P =0.06) after disc surgery. The risk of recurrent VTE 1-5 years after the index event was significantly lower in the surgery group (HR = 0.47, CI: 0.41-0.53). Within the surgery-provoked group, the risk of recurrent VTE was similar in men and women (HR = 1.0, CI: 0.8-1.3). Conclusions: The risk of recurrent VTE after surgery-provoked VTE was approximately 50% lower than after unprovoked VTE, confirming the view that provoked VTE is associated with a lower risk of recurrent VTE. However, there was appreciable heterogeneity in the relative risk of recurrent VTE associated with different operations.

KW - Epidemiology

KW - Outcomes

KW - Provoked

KW - Recurrent

KW - Surgery

KW - Unprovoked

KW - Venous thromboembolism

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