title: Predicting the risk of venous thromboembolism recurrence.
abstract: Venous thromboembolism (VTE) is a chronic disease with a 30% ten-year recurrence rate. The highest incidence of recurrence is in the first 6 months. Active cancer significantly increases the hazard of early recurrence, and the proportions of time on standard heparin with an APTT ≥ 0.2 anti-X(a) U/mL, and on warfarin with an INR ≥ 2.0, significantly reduce the hazard. The acute treatment duration does not affect recurrence risk after treatment is stopped. Independent predictors of late recurrence include increasing patient age and body mass index, leg paresis, active cancer and other persistent VTE risk factors, idiopathic VTE, antiphospholipid antibody syndrome, antithrombin, protein C or protein S deficiency, hyperhomocysteinemia and a persistently increased plasma fibrin D-dimer. A recommendation for secondary prophylaxis should be individualized based on the risk for recurrent VTE (especially fatal pulmonary embolism) and bleeding. The appropriateness of secondary prophylaxis should be continuously reevaluated, and the prophylaxis stopped if the benefit no longer exceeds the risk.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA. heit.john@mayo.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Heit
mesh_terms: D000367:Age Factors; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000628:therapy; D015992:Body Mass Index; D002908:Chronic Disease; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000150:complications / Q000628:therapy; D019934:International Normalized Ratio / Q000009:adverse effects; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000628:therapy; D010291:Paresis / Q000097:blood / Q000150:complications / Q000628:therapy; D020151:Protein C Deficiency / Q000097:blood / Q000150:complications / Q000628:therapy; D018455:Protein S Deficiency / Q000097:blood / Q000150:complications / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014859:Warfarin; D006493:Heparin