Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?

Abstract

Recurrent venous thromboembolism (VTE, or deep vein thrombosis and pulmonary embolism) is associated with mortality and long-term morbidity. The circumstances in which an index VTE event occurred are crucial when personalized VTE recurrence risk is assessed. Patients who experience a VTE event in the setting of a transient major risk factor (such as surgery associated with general anesthesia for >30 minutes) are predicted to have a low VTE recurrence risk following discontinuation of anticoagulation, and limited-duration anticoagulation is generally recommended. In contrast, those patients whose VTE event occurred in the absence of risk factors or who have persistent risk factors have a higher VTE recurrence risk. Here, we review the literature surrounding VTE recurrence risk in a range of clinical conditions. We describe gender-specific risks, including VTE recurrence risk following hormone- and pregnancy-associated VTE events. Finally, we discuss how the competing impacts of VTE recurrence and bleeding have shaped international guideline recommendations.

Incidence and Predictors of Recurrence and Mortality Following First Venous Thromboembolism Among the Saudi Population: Single-Center Cohort Study

“…24 The outcome variations of the first VTE may be influenced by the longterm follow-up, introduction of new guidelines, novel treatment modalities, and increased awareness among treating clinicians as well as patients. 21,25,26 In line with previous reports, 23,[27][28][29][30] the independent predictors of recurrence in our study were active cancer, immobilization, infection, PE ± DVT, and admission to ICU. Patients with cancer-related VTE were reported among those with the highest risk of VTE recurrence, with a range of 2-to 9-fold increased risk compared to non-cancer 28 In a cohort study of 543 patients, where a prediction score of VTE recurrence was developed, authors found a higher risk of recurrence among cancer-associated VTE patients with a score of ≥1.…”

“…The cumulative incidence of first VTE during this study period was 1.7 per 1000 patients. Of the 1124 patients with a first VTE event, 214 patients had recurrent VTE during the follow-up period (median of 29 months; interquartile range (IQR), [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. The overall incidence rate of recurrent VTE was 15.8 (95% CI, 13.8-18.0) per 100 person-years (PY).…”

Pulmonary embolism after discharge for COVID-19: A report of two cases

“…Both patients were males, above 60 years of age, and BMI was above average (respectively 27 and 32) and therefore shared some of the characteristics that are known to increase the risk of VTE. 4 Both patients received thromboprophylaxis after readmission.…”

Cancer‐related stroke: Exploring personalized therapy strategies

“…The risk of venous thromboembolism (VTE) in patients with active cancer is four to eight times that of normal people (Salazar‐Camelo et al., 2021 ). Áinle & Kevane ( 2020 ) and Porfidia et al. ( 2019 ) have shown that after VTE, the risk of stroke and other related arterial embolism is greatly increased (.…”