TY - JOUR
T1 - Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review.
AU - Siragusa, Sergio
AU - Palareti, Gualtiero
AU - Marcucci, Maura
AU - Macura, Ana
AU - Kearon, Clive
AU - Filippucci, Esmeralda
AU - Pengo, Vittorio
AU - Iorio, Alfonso
PY - 2010
Y1 - 2010
N2 - We aimed to determine the risk of recurrence for symptomatic venous thromboembolism (VTE) provoked by different transient risk factors.DATA SOURCES:MEDLINE, EMBASE, and Cochrane Collaboration Registry of Randomized Trials databases were searched.STUDY SELECTION:Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified.DATA EXTRACTION:Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted.DATA SYNTHESIS:Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTE was 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months.CONCLUSIONS:The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment.
AB - We aimed to determine the risk of recurrence for symptomatic venous thromboembolism (VTE) provoked by different transient risk factors.DATA SOURCES:MEDLINE, EMBASE, and Cochrane Collaboration Registry of Randomized Trials databases were searched.STUDY SELECTION:Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified.DATA EXTRACTION:Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted.DATA SYNTHESIS:Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTE was 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months.CONCLUSIONS:The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment.
KW - recurrent event
KW - venous thrombosis
KW - recurrent event
KW - venous thrombosis
UR - http://hdl.handle.net/10447/79627
M3 - Article
VL - 170
SP - 1710
EP - 1716
JO - JAMA Internal Medicine
JF - JAMA Internal Medicine
SN - 2168-6106
ER -