Predictors of Venous Thromboembolism Recurrence, Adjusted for Treatments and Interim Exposures: A Population-based Case-cohort Study

Abstract

Background Predictors of venous thromboembolism (VTE) recurrence are uncertain. Objective To identify predictors of VTE recurrence, adjusted for treatments and interim exposures. Materials and Methods Using Rochester Epidemiology Project resources, all Olmsted County, MN residents with objectively-diagnosed incident VTE over the 13-year period, 1988–2000, who survived ≥1 day were followed for first objectively-diagnosed VTE recurrence. For all patients with recurrence, and a random sample of all surviving incident VTE patients (n=415), we collected demographic and baseline characteristics, treatments and interim exposures. In a case-cohort study design, demographic, baseline, treatment and interim exposure characteristics were tested as potential predictors of VTE recurrence using time-dependent Cox proportional hazards modeling. Results Among 1262 incident VTE patients, 306 developed recurrence over 6,440 person-years. Five-year recurrence rates, overall and for cancer-associated, idiopathic and non-cancer secondary VTE, were 24.5%, 43.4%, 27.3% and 18.1%, respectively. In multivariable analysis, interim hospitalization, active cancer, pregnancy, central venous catheter and respiratory infection were associated with increased hazards of recurrence, and warfarin and aspirin were associated with reduced hazards. Adjusting for treatments and these interim risk factors, male sex, baseline active cancer and failure to achieve a therapeutic aPTT in the first 24 hours were independently associated with increased hazards of VTE recurrence over the entire follow-up period, while the hazards of recurrence for patient age, chronic lung disease, leg paresis, prior superficial vein thrombosis and idiopathic VTE varied over the follow-up period. Conclusions Baseline and interim exposures can stratify VTE recurrence risk and may be useful for directing secondary prophylaxis.

Recurrence and mortality after first venous thromboembolism in a large population‐based cohort

“…In agreement with previous studies [25,26], the 5-year cumulative risk of recurrence was highest among cancer patients. The mortality rate is high among cancer patients, and, in the presence of competing risk of death, the cumulative incidence of recurrence is dependent on both the risk of recurrence and the risk of dying [23,24,31].…”

Portomesenteric vein thrombosis after gastric surgery

“…Therefore, they interact with all parts of the hemostatic system. We also used age and sex as matching parameters although there was no correlation in univariate analysis, because advanced age ([60 years) has been shown as an independent risk factor of venous thromboembolism in previous studies [11,12], and some reports suggest that sex hormones affect thrombosis [13,14].…”

Risk factors for incident venous thromboembolism in active cancer patients: A population based case–control study

“…[47, 48] For this study, we included all Olmsted County residents who consented to access of their medical records for research purposes and had a first lifetime symptomatic leg DVT or PE during the 28-year period, 1973-2000, and active cancer in the three months prior to or after the VTE diagnosis as previously defined. [28, 49] Briefly, a cancer was considered as active if any evidence of cancer (i.e., diagnosis, treatment, progression, oncologist review) was found via medical record review within 92 days prior to the VTE event/index date. At a minimum, any newly diagnosed cancer was considered as active for 6 months from the diagnosis date if not treated by curative surgery.…”