title: The long-term recurrence risk of patients with unprovoked venous thromboembolism: an observational cohort study.
abstract: Essentials Long-term recurrence risk of venous thromboembolism (VTE) is uncertain. We performed a prospective cohort study of 839 patients with first unprovoked VTE. VTE recurrence risk is high, particularly in men with proximal thrombosis or pulmonary embolism. Sex and VTE site determine the recurrence risk and should be considered for patient counseling.
  
  
  
  Background The long-term recurrence risk (ltRR) of venous thromboembolism (VTE) is uncertain. Objective To assess the ltRR of patients with first unprovoked VTE. Patients/methods Patients were classified into three categories: distal deep vein thrombosis (DVT), proximal DVT or pulmonary embolism (PE), that is, PE associated with DVT or isolated PE. Patients with major thrombophilia or antithrombotic therapy were excluded. The endpoint was recurrent symptomatic VTE. Results A total of 839 patients were followed for a median of 7.7 years. VTE recurred in 263 patients (31%). After 10 and 20 years, the cumulative ltRR was 32% (95% confidence interval [CI], 29-36) and 44% (95% CI, 38-49) with 3.9 (95% CI, 3.3-4.6) and 3.3 (95% CI, 2.7-4.0) events per 100 patient-years, respectively. The adjusted hazard ratio was 2.1 (95% CI, 1.4-3.2) and 2.1 (95% CI, 1.4-3.2) for patients with proximal DVT or PE compared with patients with distal DVT and was 2.1 (95% CI, 1.6-2.9) for men compared with women. At 10 years, 4.7 (95% CI, 3.8-5.8) events per 100 patient-years occurred in men with proximal DVT or PE, 2.4 (95% CI, 1.2-4.4) in men with distal DVT, 1.9 (95% CI, 1.2-2.8) in women with proximal DVT or PE and 0.9 (95% CI, 0.2-1.9) in women with distal DVT. Conclusion The ltRR of patients with first unprovoked VTE is high and dependent upon sex and VTE site.
authors.affiliation: Department of Medicine I, General Hospital, Vienna, Austria.|Karl Landsteiner Institute of Clinical Thrombosis Research, Vienna, Austria.
authors.forename: P A
authors.initials: PA
authors.lastname: Kyrle
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Kammer
authors.affiliation: Department of Medicine I, General Hospital, Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Eischer
authors.affiliation: Department of Medicine I, Krankenhaus der Elisabethinen, Linz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Weltermann
authors.affiliation: Department of Medicine II, General Hospital, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Minar
authors.affiliation: Department of Angiology, Hanuschkrankenhaus, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Hirschl
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Department of Medicine I, General Hospital, Vienna, Austria.|Karl Landsteiner Institute of Clinical Thrombosis Research, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Eichinger
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001317:Austria; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012008:Recurrence; D012737:Sex Factors; D019851:Thrombophilia / Q000150:complications; D013997:Time Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: deep vein thrombosis; observational study; pulmonary embolism; relapse; venous thromboembolism