The risk of recurrent venous thromboembolism after discontinuation of anticoagulant therapy in patients with cancer-associated thrombosis: a systematic review and meta-analysis

Risk of recurrent venous thromboembolism in cancer patients after discontinuation of anticoagulant therapy

“…The cumulative incidence of recurrent VTE after discontinuation was 10.2% [95% confidence interval (CI), 9.1 to 11.5 %] at 1 year, 19.7% (95% CI, 17.0 to 22.5%) at 5 years, and 27.6% (95% CI, 22.1 to 33.3%) at 10 years. 11 The cumulative incidence of recurrence after discontinuing anticoagulant therapy did not change according to the length of previous treatment. In a cohort comparison of 6,532 patients with cancer-associated VTE who did not have a recurrence during the first 3 months and were receiving continued anticoagulant treatment, the corresponding cumulative rates of recurrent VTE at 1, 5 and 10 years were 3.2% (95% CI, 2.6 to 4.0%), 6.0% (95% CI, 4.2 to 8.3%) and 13.5% (95% CI, 5.9 to 9.5%).…”

“…First, there is a high cumulative incidence of recurrent VTE, more than 30%, during the 5 years following discontinuation of treatment. 11 The risk of recurrence is highest during the initial 6 months, with reported rates of approximately 10% to 15% (Table 1). Recurrences continue to accumulate significantly to 31% at 2 years, with the cumulative incidence stabilizing between years 2 and 5 (Table 2).…”

“…10 The rates of major bleeding were 1-4% among patients receiving continued anticoagulation. 10 A recent systematic review and meta-analysis by van Hylckama Vlieg et al 11 provides important new data on the risk of recurrent VTE after discontinuing anticoagulation in patients with cancer-associated VTE. These authors assessed the rate of recurrent VTE and the cumulative rate of VTE recurrence in patients with a first cancer-associated VTE who completed at least 3 months of anticoagulant treatment and were followed up after discontinuation of this treatment.…”

“…The rate of VTE recurrence for these intervals ranged from 14.6% to 1.1%, with the highest risk during the early periods after discontinuing therapy. 11 The cumulative rates of recurrent VTE for up to 5 years after discontinuing treatment are summarized in Table 2. The results document high cumulative rates of recurrent VTE, ranging from 23% at 6 months after discontinuation of anticoagulant treatment to more than one-third of patients having a recurrence within 5 years.…”

“…The results document high cumulative rates of recurrent VTE, ranging from 23% at 6 months after discontinuation of anticoagulant treatment to more than one-third of patients having a recurrence within 5 years. 11 The authors discussed several limitations of the study, several of which would likely cause the results to be an underestimate of the recurrence rate after discontinuing therapy. The cumulative rates of recurrent VTE are so high that the limitations of the study would be unlikely to lead to different conclusions.…”