VTE recurrence risks in selected studies evaluating risk factors for recurrence
| Study . | Type of study/nature of initial VTE* . | Cumulative recurrence risk for entire group . | Predictors of VTE recurrence . | VTE recurrence risk RR or HR (95% CI) . |
|---|---|---|---|---|
| Heit et al 2000 (45) | Prospective cohort study: provoked and unprovoked first VTE | 1 y: 12.9% | Male sex | Male vs. Female: HR 1.29 (1.06-1.57) |
| 10 y: 30.4% | Definite/probable VTE: 2.07 (1.60-2.67) | |||
| Kyrle et al 2004 (46) | Prospective cohort study: first unprovoked VTE | 5 y: | Male sex | Male vs. Female: RR 3.6 (2.3-5.5) |
| Men: 30.7% (23.8-37.6) | ||||
| Women: 8.5% (5.0-12.0) | ||||
| Baglin et al 2004 (47) | Prospective single-center cohort study: provoked/unprovoked VTE | 2 y: | Male sex | Male vs. Female: HR 2.66 (1.49-4.77) |
| Men: 19.2% | ||||
| Women: 7.7% | ||||
| Rodger et al 2008 (42) | Multicenter prospective cohort study: First unprovoked VTE | N/R | Male sex | Annual recurrence risk: |
| Men 13.7% (10.8-17.0%) | ||||
| Women: 5.5% (3.7-7.8%); P < .001 | ||||
| Lijfering et al 2009 (48) | Post hoc analysis of pooled data from family cohort studies: Provoked and unprovoked VTE | N/R | Male sex | Male vs. Female: RR 1.6 (95% CI, 1.3-2.0) |
| Christiansen et al 2010 (33) | Prospective follow-up of case-control study; provoked and unprovoked first VTE | N/R | Male sex | Men: IR 41.2/1000 patient-years |
| Women: IR 14.2/1000 patient -years | ||||
| HR 2.8 (1.4-5.7) (unprovoked VTE) | ||||
| Douketis et al 2011 (49) | Patient-level meta-analysis (provoked and unprovoked VTE) | 1 y: | Male sex | Male vs. Female: HR 2.2 (1.7-2.8) |
| Men: 9.5% (7.9%-11.4%) | ||||
| Women: 5.3% (4.1%-6.7%) | ||||
| 3 y: | ||||
| Men: 19.7% (16.5%-23.4%) | ||||
| Women: 9.1% (7.3% −11.3%) | ||||
| Khan et al 2019 (8) | Meta-analysis first unprovoked VTE | 2 y: 16% (13-19%) | Male sex | First year: |
| 5 y: 25% (21- 29%) | Men: 11.9/100 patient-years (9.6-14.4) Women: 8.9/100 patient-years (6.8-11.3) | |||
| 10 y: 36% (28-45%) | Rate ratio 1.4 (1.3-1.6) | |||
| Palareti et al 2006 (50) | RCT first unprovoked VTE | N/R | D-dimer 1 mo after D/C AC | HR (abnormal vs normal D-dimer without AC) 2.49 (1.35–4.59) |
| Verhovsek et al 2008 (51) | Meta-analysis (first unprovoked VTE) | N/R | Abnormal D-dimer levels after anticoagulation completion | Positive D-dimer results: |
| −8.9%/year (5.8%-11.9%) | ||||
| Negative D-dimer results: | ||||
| −3.5%/year (2.7%-4.3%) | ||||
| Cosmi et al 2010 (52) | Prospective multicenter study (first unprovoked VTE) | N/R | D-dimer 1 mo after D/C AC | Persistently abnormal D-dimer: 27%/person-years (12-48) |
| Persistently normal D-dimer: 2.9%/person-years (1-7) | ||||
| Adjusted HR 7.9 (2.1-30) | ||||
| Palaretti et al 2014 (53) | Prospective clinical management study (VTE associated with no/weak risk factors) | N/R | D-dimers after AC | 1. Persistently negative D-dimer after D/C AC: |
| 3.0 per 100 person-years (2.0-4.4) | ||||
| 2. Positive D-dimers, refused to resume AC: | ||||
| 8.8 per 100 person-years (5-14.1) | ||||
| HR 1 vs 2: 2.92 (1.87-9.72) | ||||
| Kearon et al 2015 (29) | Prospective clinical management study (first unprovoked VTE) | N/R | D-dimers at end of AC: if second test negative >1 mo, AC not restarted in men/women | Persistently negative D-dimers: |
| Overall: 6.7% (4.8-9.0%)/person-year | ||||
| Men: 9.7% (6.7-13.7%)/person-year | ||||
| Nonestrogen women: 5.4% | ||||
| (2.5-10.2%)/person-year | ||||
| Estrogen women: 0.0% (0.0-3.0%)/person-year | ||||
| Tan et al 2011 (54) | Systematic review: studies including provoked and unprovoked first VTE | N/R | Residual vein thrombosis | Residual vein thrombosis vs. none: Overall: OR 2.02 (1.62-2.5), unprovoked VTE: OR 1.5 (1.12-2.01) |
| Carrier et al 2011 (55) | Systematic review (unprovoked and provoked first VTE) | N/R | Residual vein occlusion | Residual vein occlusion vs. none: Any VTE: OR 1.5 (1.1-2.0) unprovoked VTE: OR 1.24 (0.9-1.7) |
| Study . | Type of study/nature of initial VTE* . | Cumulative recurrence risk for entire group . | Predictors of VTE recurrence . | VTE recurrence risk RR or HR (95% CI) . |
|---|---|---|---|---|
| Heit et al 2000 (45) | Prospective cohort study: provoked and unprovoked first VTE | 1 y: 12.9% | Male sex | Male vs. Female: HR 1.29 (1.06-1.57) |
| 10 y: 30.4% | Definite/probable VTE: 2.07 (1.60-2.67) | |||
| Kyrle et al 2004 (46) | Prospective cohort study: first unprovoked VTE | 5 y: | Male sex | Male vs. Female: RR 3.6 (2.3-5.5) |
| Men: 30.7% (23.8-37.6) | ||||
| Women: 8.5% (5.0-12.0) | ||||
| Baglin et al 2004 (47) | Prospective single-center cohort study: provoked/unprovoked VTE | 2 y: | Male sex | Male vs. Female: HR 2.66 (1.49-4.77) |
| Men: 19.2% | ||||
| Women: 7.7% | ||||
| Rodger et al 2008 (42) | Multicenter prospective cohort study: First unprovoked VTE | N/R | Male sex | Annual recurrence risk: |
| Men 13.7% (10.8-17.0%) | ||||
| Women: 5.5% (3.7-7.8%); P < .001 | ||||
| Lijfering et al 2009 (48) | Post hoc analysis of pooled data from family cohort studies: Provoked and unprovoked VTE | N/R | Male sex | Male vs. Female: RR 1.6 (95% CI, 1.3-2.0) |
| Christiansen et al 2010 (33) | Prospective follow-up of case-control study; provoked and unprovoked first VTE | N/R | Male sex | Men: IR 41.2/1000 patient-years |
| Women: IR 14.2/1000 patient -years | ||||
| HR 2.8 (1.4-5.7) (unprovoked VTE) | ||||
| Douketis et al 2011 (49) | Patient-level meta-analysis (provoked and unprovoked VTE) | 1 y: | Male sex | Male vs. Female: HR 2.2 (1.7-2.8) |
| Men: 9.5% (7.9%-11.4%) | ||||
| Women: 5.3% (4.1%-6.7%) | ||||
| 3 y: | ||||
| Men: 19.7% (16.5%-23.4%) | ||||
| Women: 9.1% (7.3% −11.3%) | ||||
| Khan et al 2019 (8) | Meta-analysis first unprovoked VTE | 2 y: 16% (13-19%) | Male sex | First year: |
| 5 y: 25% (21- 29%) | Men: 11.9/100 patient-years (9.6-14.4) Women: 8.9/100 patient-years (6.8-11.3) | |||
| 10 y: 36% (28-45%) | Rate ratio 1.4 (1.3-1.6) | |||
| Palareti et al 2006 (50) | RCT first unprovoked VTE | N/R | D-dimer 1 mo after D/C AC | HR (abnormal vs normal D-dimer without AC) 2.49 (1.35–4.59) |
| Verhovsek et al 2008 (51) | Meta-analysis (first unprovoked VTE) | N/R | Abnormal D-dimer levels after anticoagulation completion | Positive D-dimer results: |
| −8.9%/year (5.8%-11.9%) | ||||
| Negative D-dimer results: | ||||
| −3.5%/year (2.7%-4.3%) | ||||
| Cosmi et al 2010 (52) | Prospective multicenter study (first unprovoked VTE) | N/R | D-dimer 1 mo after D/C AC | Persistently abnormal D-dimer: 27%/person-years (12-48) |
| Persistently normal D-dimer: 2.9%/person-years (1-7) | ||||
| Adjusted HR 7.9 (2.1-30) | ||||
| Palaretti et al 2014 (53) | Prospective clinical management study (VTE associated with no/weak risk factors) | N/R | D-dimers after AC | 1. Persistently negative D-dimer after D/C AC: |
| 3.0 per 100 person-years (2.0-4.4) | ||||
| 2. Positive D-dimers, refused to resume AC: | ||||
| 8.8 per 100 person-years (5-14.1) | ||||
| HR 1 vs 2: 2.92 (1.87-9.72) | ||||
| Kearon et al 2015 (29) | Prospective clinical management study (first unprovoked VTE) | N/R | D-dimers at end of AC: if second test negative >1 mo, AC not restarted in men/women | Persistently negative D-dimers: |
| Overall: 6.7% (4.8-9.0%)/person-year | ||||
| Men: 9.7% (6.7-13.7%)/person-year | ||||
| Nonestrogen women: 5.4% | ||||
| (2.5-10.2%)/person-year | ||||
| Estrogen women: 0.0% (0.0-3.0%)/person-year | ||||
| Tan et al 2011 (54) | Systematic review: studies including provoked and unprovoked first VTE | N/R | Residual vein thrombosis | Residual vein thrombosis vs. none: Overall: OR 2.02 (1.62-2.5), unprovoked VTE: OR 1.5 (1.12-2.01) |
| Carrier et al 2011 (55) | Systematic review (unprovoked and provoked first VTE) | N/R | Residual vein occlusion | Residual vein occlusion vs. none: Any VTE: OR 1.5 (1.1-2.0) unprovoked VTE: OR 1.24 (0.9-1.7) |
AC, anticoagulation; D/C, discontinued; HR, hazard ratio; N/R, not reported; OR: odds ratio; RR, relative risk.
In these studies, VTE events included DVT and PE.