Clinical significance of recurrent venous thromboembolism

Abstract

Recurrent venous thromboembolism is a significant problem leading to increased morbidity and mortality. It has a high impact on patients' quality of life and imposes a great financial burden on society. Cumulative recurrence has been reported as 40% at 10 years, while the chance of developing postthrombotic signs and symptoms in the lower extremities almost quadruples when ipsilateral. There is also a higher chance of developing pulmonary hypertension. Important factors for recurrence are unprovoked episodes of deep vein thrombosis, malignancy and older age. The evidence for other factors is controversial. Accurate diagnosis and treatment tailored to the patients' history, thrombotic events and risk factors are necessary to optimize management and prevent recurrence.

Family history of venous thromboembolism (VTE) and risk of recurrent hospitalization for VTE: a nationwide family study in Sweden

“…Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) of the lower extremities and pulmonary embolism (PE), is often a chronic disease, with a risk of recurrence within 5 years of~25% [1][2][3]. VTE recurrence can be prevented with anticoagulants, but their use increases the risk of bleeding [4][5][6].…”

“…Risk assessment is therefore important to balance the risks and benefits of anticoagulant therapy [4][5][6]. However, the risk of recurrent thrombosis after stopping treatment is not easily predicted, although a number of risk factors for recurrent VTE have been identified [1][2][3][4][5][6][7]. The risk of recurrent VTE is especially high in patients with unprovoked VTE (i.e.…”

“…The risk of recurrent VTE is especially high in patients with unprovoked VTE (i.e. VTE in the absence of transitory risk factors such as surgery, trauma, pregnancy, and oral contraceptive use) [1][2][3][4][5][6][7]. Other risk factors for recurrent VTE include PE (as compared with DVT), proximal DVT (as compared with distal DVT), male sex, cancer, obesity, residual venous thrombosis, and elevated D-dimer levels [1][2][3][4][5][6][7].…”

“…VTE in the absence of transitory risk factors such as surgery, trauma, pregnancy, and oral contraceptive use) [1][2][3][4][5][6][7]. Other risk factors for recurrent VTE include PE (as compared with DVT), proximal DVT (as compared with distal DVT), male sex, cancer, obesity, residual venous thrombosis, and elevated D-dimer levels [1][2][3][4][5][6][7]. Several genetic defects, such as deficiencies of antithrombin, protein C, and protein S, resistance to activated protein C (APC) (APC resistance or the presence of factor V Leiden, rs6025), prothrombin mutations (rs1799963), and non-O blood group, have been associated with an increased risk of a first VTE event [8,9].…”

“…Several genetic defects, such as deficiencies of antithrombin, protein C, and protein S, resistance to activated protein C (APC) (APC resistance or the presence of factor V Leiden, rs6025), prothrombin mutations (rs1799963), and non-O blood group, have been associated with an increased risk of a first VTE event [8,9]. However, the clinical importance of these inherited genetic defects in recurrent VTE risk is controversial [1][2][3]7]. Moreover, the predictive value of the family history for any of these genetic defects is low [10], suggesting that many unknown genetic defects remain to be identified.…”