Impact and clinical significance of recurrent venous thromboembolism.
BACKGROUND
The purpose of this review was to analyse current knowledge and controversies associated with the diagnosis, treatment and prevention of recurrent venous thromboembolism (VTE).


METHODS
MEDLINE and manual searches were performed to select prospective papers on the diagnosis, treatment and prevention of recurrent VTE for their relevance and quality.


RESULTS
The cumulative incidence of recurrent VTE increases from 11 per cent at 1 year to 40 per cent at 10 years. The incidence of recurrence is higher in unprovoked thrombosis compared with provoked VTE. Patients with unprovoked deep vein thrombosis also have a greater number of multiple recurrences. Ultrasonography or D-dimer monitoring may have an impact on the duration of anticoagulation but further refinements are needed. The incidence of skin damage is higher in ipsilateral recurrence compared with contralateral or no recurrence. Legs with ipsilateral recurrence more often have both reflux and obstruction.


CONCLUSIONS
The role and weight of the predictive factors for recurrent VTE and its sequelae, and the type and optimal duration of anticoagulation have not been studied adequately. Fatality associated with pulmonary embolism and rates of recurrent VTE remain unacceptably high.
Labropoulos
N
N
Stony Brook University Medical Center, Stony Brook, New York, USA. nlabrop@yahoo.com
Spentzouris
G
G
Gasparis
A P
AP
Meissner
M
M
D000925:Anticoagulants / Q000627:therapeutic use; D003952:Diagnostic Imaging; D019320:Embolism, Paradoxical / Q000209:etiology; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D055118:Medication Adherence; D010808:Physical Examination; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D