title: Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis.
abstract: OBJECTIVE
  To determine if the mode of presentation of venous thromboembolism (VTE), as deep vein thrombosis (DVT) or pulmonary embolism (PE), predicts the likelihood and type of recurrence.
  
  
  METHODS
  We carried out a patient-level meta-analysis of seven prospective studies in patients with a first VTE who were followed after anticoagulation was stopped. We used Kaplan-Meier analysis to determine the cumulative incidence of recurrent VTE according to mode of presentation, and multivariable Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mode of and extent of DVT as potential risk factors for recurrence.
  
  
  RESULTS
  The 5-year cumulative rate of recurrent VTE in 2554 patients was 22.6%. In 869 (36.1%) patients with PE, the 5-year rate of any recurrence (DVT or PE) was 22.0%, and recurrence as PE was 10.6%. In 1365 patients with proximal DVT, the 5-year recurrence rate was 26.4%, and recurrence with PE was 3.6%. The risk of recurrence as PE was 3.1-fold greater in patients presenting with symptomatic PE than in patients with proximal DVT (HR, 3.1; 95% CI, 1.9-5.1). Patients with proximal DVT had a 4.8-fold higher cumulative recurrence rate than those with distal DVT (HR, 4.8; 95% CI, 2.1-11.0).
  
  
  CONCLUSIONS
  Whilst DVT and PE are manifestations of the same disease, the phenotypic expression is predetermined. Patients presenting with PE are three times more likely to suffer recurrence as PE than patients presenting with DVT. Patients presenting with calf DVT are at low risk of recurrence and at low risk of recurrence as PE.
authors: Department of Haematology, Addenbrooke's Hospital, Cambridge, UK. trevor.baglin@addenbrookes.nhs.uk
authors: T
authors: T
authors: Baglin
authors: J
authors: J
authors: Douketis
authors: A
authors: A
authors: Tosetto
authors: M
authors: M
authors: Marcucci
authors: M
authors: M
authors: Cushman
authors: P
authors: P
authors: Kyrle
authors: G
authors: G
authors: Palareti
authors: D
authors: D
authors: Poli
authors: R C
authors: RC
authors: Tait
authors: A
authors: A
authors: Iorio
mesh_terms: D000925:Anticoagulants / Q000378:metabolism; D015331:Cohort Studies; D005338:Fibrin Fibrinogen Degradation Products / Q000096:biosynthesis; D006801:Humans; D018482:Muscle, Skeletal / Q000473:pathology; D010641:Phenotype; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D