Venous thromboembolism: risk factors for recurrence.
Patients who have a first episode of venous thromboembolism (VTE) have an elevated risk of a recurrent episode, and this necessitates secondary prophylaxis. Anticoagulant therapy is a double-edged sword, however, as it reduces the risk of recurrent VTE but increases the risk of hemorrhage. This balance must be taken into account when assessing the risk-benefit ratio of long-term anticoagulation. Some clinical characteristics of the index VTE event can help to categorize the individual risk of recurrence. Patients with persistent risk factors such as cancer have a significantly higher risk of recurrent thrombosis. In contrast, VTE provoked by transient risk factors is associated with a lower risk of recurrence. Intrinsic features of patients with VTE (gender, age, hereditary thrombophilia) have also been linked to the risk of recurrent VTE. There is increasing evidence that a normal D-dimer level and the absence of residual venous thrombosis after discontinuation of oral anticoagulation are associated with a lower risk of recurrent VTE events. Future studies are needed to refine the predictive value of known risk factors for VTE recurrence and to discover better markers.
Zhu
Tienan
T
University Paris Descartes, Inserm U765, Service de Médecine Vasculaire-HTA, Paris, France.
Martinez
Isabelle
I
Emmerich
Joseph
J
D000284:Administration, Oral; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D012737:Sex Factors; D013917:Thrombin / Q000378:metabolism; D019851:Thrombophilia / Q000150:complications; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology*; D020246:Venous Thrombosis / Q000097:blood / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology*
D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D013917:Thrombin