Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study

• Published in: The Lancet (British edition) Vol. 362; no. 9383; pp. 523 - 526
• Main Authors: Baglin, Trevor, Luddington, Roger, Brown, Karen, Baglin, Caroline
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 16.08.2003; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - therapeutic use; Antithrombin III Deficiency - diagnosis; Antithrombin III Deficiency - epidemiology; Blood vessels; Cohort Studies; Comorbidity; Disease management; Female; Follow-Up Studies; Hemorrhage; Humans; Incidence; Laboratory tests; Male; Medical disorders; Middle Aged; Mutation; Prospective Studies; Protein C Deficiency - diagnosis; Protein C Deficiency - epidemiology; Protein S Deficiency - diagnosis; Protein S Deficiency - epidemiology; Recurrence; Risk Factors; Thromboembolism; Thromboembolism - drug therapy; Thromboembolism - epidemiology; Thrombophilia - diagnosis; Thrombophilia - epidemiology; Thrombophilia - genetics; Venous Thrombosis - drug therapy; Venous Thrombosis - epidemiology
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)14111-6

Stratification for risk of recurrence after a first episode of venous thromboembolism (VTE) would affect the duration of anticoagulant therapy. We aimed to determine the incidence of recurrence of VTE in relation to clinical risk factors and standard laboratory testing for heritable thrombophilic defects. We established a database to prospectively follow-up a cohort of unselected patients who had had a first episode of objectively proven VTE. We excluded patients with malignant disease and antiphospholipid syndrome. All patients were offered testing for heritable thrombophilia. At 2 years, the cumulative recurrence rate in 570 patients was 11%. Incidence was lowest after surgery-related VTE (0%) and highest after unprecipitated VTE (19·4%) (p<0·001). 85% of patients were tested for heritable thrombophilic defects. Recurrence rates were not related to presence or absence of laboratory evidence of heritable thrombophilia (hazard ratio 1·50 [95% CI 0·82–2·77]; p=0·187). In patients with a first event that was unprecipitated or was associated with a non-surgical trigger, recurrence rates did not differ in patients with or without thrombophilia (1·34 [0·73–2·46]; p=0·351). In unselected patients who have had a first episode of VTE, testing for heritable thrombophilia does not allow prediction of recurrent VTE in the first 2 years after anticoagulant therapy is stopped. However, assessment of clinical risk factors associated with the first episode of VTE does predict risk of recurrence. Patients with postoperative VTE have a very low rate of recurrence.