Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

Weingarz, Lea; Schindewolf, Marc; Schwonberg, Jan; Hecking, Carola; Wolf, Zsuzsanna; Erbe, Matthias; Lindhoff-Last, Edelgard; Linnemann, Birgit

doi:10.1024/0301-1526/a000447

Cited by 13 publications

(17 citation statements)

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“…We abstracted the following patient baseline variables that have previously been described as predictors of venous thromboembolism recurrence from our database: age, 3,4 male sex, 3,5 obesity (defined as BMI ≥30kg/m 2 ), 4 localization of index venous thromboembolism (pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis), 6,7 type of index venous thromboembolism (provoked, unprovoked, cancer-related), 3,8 prior venous thromboembolism, 9 family history of venous thromboembolism, 10 inflammatory bowel disease, 11 chronic heart failure, 12 leg paresis (hemiparesis, hemiplegia, paraplegia), 13 varicose vein surgery (a proxy for varicose veins), 4 D-dimer levels at baseline, 14 and thrombophilia (factor V Leiden or prothrombin G20210A mutation). 10,15 Provoked venous thromboembolism was defined as venous thromboembolism following major surgery, estrogen therapy or immobilization (bed rest for more than 72 hours, travel in a sitting position for more than six hours, fracture or a cast of the lower extremity) during the last three months.…”

Section: Predictors Of Recurrent Vtementioning

confidence: 99%

“…1 As venous thromboembolism tends to recur, 2,3 the risk of recurrence is an important determinant of the duration of anticoagulant therapy. Several patient characteristics are associated with recurrent venous thromboembolism, including age, 3,4 male sex, 3,5 obesity, 4 localization of venous thromboembolism, 6,7 unprovoked venous thromboembolism, 3,8 cancer-related venous thromboembolism, 2,3 prior venous thromboembolism, 9 family history of venous thromboembolism, 10 inflammatory bowel disease, 11 chronic heart failure, 12 leg paresis, 13 varicose veins, 4 elevated D-dimer at baseline, 14 or thrombophilia. 10,15 Treatment-related factors associated with venous thromboembolism recurrence include a suboptimal anticoagulation quality and the insertion of a vena cava filter, 2,16 whereas thrombolysis, 17 initial therapy with lowmolecular-weight heparin (LMWH), 18 and concomitant use of statins or antiplatelet therapy may have a protective effect.…”

Section: Introductionmentioning

confidence: 99%

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Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Lauber

Limacher

Tritschler

et al. 2018

The American Journal of Medicine

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Section: Predictors Of Recurrent Vtementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Lauber

Limacher

Tritschler

et al. 2018

The American Journal of Medicine

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“…A total of 10 studies were used. In six studies, anticoagulant treatment was short term, 36,37,[42][43][44][45] in one study long term, 40 and in three studies both long term and short term. 38,39,41 These studies contained data on 231 antithrombin-deficient individuals, of which 97 (42%) had a recurrence.…”

Section: Risk Of Recurrent Venous Thromboembolismmentioning

confidence: 99%

“…38,39,41 These studies contained data on 231 antithrombin-deficient individuals, of which 97 (42%) had a recurrence. [36][37][38][39][40][41][42][43][44][45] Out of 3,863 controls, 929 (24%) had a recurrence. The OR was 2.1; 95% CrI, 0.2 to 4.0, and the probability of the OR being >1 was 88%.…”

Section: Risk Of Recurrent Venous Thromboembolismmentioning

confidence: 99%

Risk of Venous Thrombosis in Antithrombin Deficiency: A Systematic Review and Bayesian Meta-analysis

Croles

Howard

Nasserinejad

et al. 2018

Semin Thromb Hemost

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Antithrombin deficiency is a strong risk factor for venous thromboembolism (VTE), but the absolute risk of the first and recurrent VTE is unclear. The objective of this paper is to establish the absolute risks of the first and recurrent VTE and mortality in individuals with antithrombin deficiency. The databases Embase, Medline Ovid, Web of Science, the Cochrane Library, and Google Scholar were systematically searched for case-control and cohort studies. Bayesian random-effects meta-analysis was used to calculate odds ratios (ORs), absolute risks, and probabilities of ORs being above thresholds. Thirty-five publications were included in the systematic review and meta-analysis. Based on 19 studies, OR estimates for the first VTE showed a strongly increased risk for antithrombin deficient individuals, OR 14.0; 95% credible interval (CrI), 5.5 to 29.0. Based on 10 studies, meta-analysis showed that the annual VTE risk was significantly higher in antithrombin-deficient than in non-antithrombin-deficient individuals: 1.2% (95% CrI, 0.8-1.7) versus 0.07% (95% CrI, 0.01-0.14). In prospective studies, the annual VTE risk in antithrombin deficient individuals was as high as 2.3%; 95% CrI, 0.2-6.5%. Data on antithrombin deficiency subtypes are very limited for reliable risk-differentiation. The OR for recurrent VTE based on 10 studies was 2.1; 95% CrI, 0.2 to 4.0. The annual recurrence risk without long-term anticoagulant therapy based on 4 studies was 8.8% (95% CrI, 4.6-14.1) for antithrombin-deficient and 4.3% (95% CrI, 1.5-7.9) for non-antithrombin-deficient VTE patients. The probability of the recurrence risk being higher in antithrombin-deficient patients was 95%. The authors conclude that antithrombin deficient individuals have a high annual VTE risk, and a high annual recurrence risk. Antithrombin deficient patients with VTE require long-term anticoagulant therapy.

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“…heterozygous Factor V Leiden or G20210A prothrombin mutation), it is higher for antithrombin defi ciency, combined defi ciencies, Factor V Leiden and Factor II G20210A homozygous mutation. Acquired thrombophilia is of great relevance and the risk of recurrence in patients with anti-phospholipid syndrome is twofold increased [14]. Several randomised trials and meta-analyses demonstrated that, once anticoagulant therapy has been stopped, males exhibit a risk of recurrence higher than females, with a relative risk varying from 1.3 to 3.6 [15,16].…”

Section: Individual Risk Of Recurrencementioning

confidence: 99%

The optimal duration of anticoagulant therapy after unprovoked venous thromboembolism – still a challenging issue

Elmi

Pasquale

Pesavento

2017

Vasa

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Summary: As about 50 % of patients with unprovoked venous thromboembolism (VTE) will develop new episodes after discontinuing therapy, indefi nite treatment is suggested in patients with low or moderate bleeding risk. Baseline and post-baseline factors can help clinicians to identify patients at high risk of recurrence, who require extended treatment. Residual vein obstruction and D-dimer assay have been shown to be suitable methods for assessing the risk of VTE recurrences after a fi rst unprovoked VTE. In treatment for VTE the use of direct oral anticoagulants (DOAC) is growing instead of the standard adjusted dose of vitamin K antagonists. The DOAC safety profi le has recently been strengthened with systematic reviews and metaanalyses. Idarucizumab is only approved for the reversal of dabigatran etexilate; intravenous antidotes for factor Xa inhibitors are under development. Their advent is of great interest. In the extended treatment of VTE sulodexide has been demonstrated to signifi cantly decrease the risk of recurrences with an excellent safety profi le. Aspirin is substantially less effective than oral anticoagulants in preventing recurrences but could play a role among patients who decided to stop anticoagulants. In conclusion, for the secondary prevention of VTE several options are available, without a recognised best choice regarding the treatment duration and the choice of drugs. An individual strategy taking into account risk of recurrence, bleeding risk, therapeutic options, and patient preferences is appropriate.Keywords: Venous thromboembolism, anticoagulation, thrombophilia, recurrence, major bleeding, fatal bleeding especially common after unprovoked VTE episodes; although the highest risk of recurrence is observed in the fi rst six months following the acute event, it remains quite relevant for a longer time. The cumulative ten-year incidence of recurrences after anticoagulant withdrawal approaches 40 % among all patients with VTE, reaching 52.6 % in unprovoked VTE and 22.5 % in provoked VTE. Patients with VTE provoked by a medical reversible risk factor are more likely to develop recurrences than patients with recent trauma or surgery (cumulative ten-year incidence of recurrences 31.8 % vs 11.4 % respectively) [3]. Moreover, a catch-up phenomenon regarding the late recurrences in the course of VTE has been demonstrated, as diff erent duration of anticoagulant therapy fail to decrease their incidence, once the anticoagulant drug has been withdrawn [4,5].Among the other late complications, PTS develops in up to 50 % of patients previously aff ected by DVT and sometimes leads to a devastating and chronic disease, characterised by leg swelling and venous ulcers.CTEPH is a rarer, but potentially fatal complication of VTE and develops in a variable rate of subjects, ranging

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Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

Abstract: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Cited by 13 publications

References 0 publications

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients

Risk of Venous Thrombosis in Antithrombin Deficiency: A Systematic Review and Bayesian Meta-analysis

The optimal duration of anticoagulant therapy after unprovoked venous thromboembolism – still a challenging issue

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