Abstract
Purpose
In this study, we aimed to estimate recurrence risk after incident venous thromboembolism,
stratified according to unprovoked, provoked, and cancer-related venous thromboembolism
in a prospective cohort of inpatients and outpatients receiving routine care.
Methods
We linked nationwide Danish health registries to identify all patients with incident
venous thromboembolism from January 2000 through December 2015. Rates of recurrence
were calculated and Cox regression was used to compute hazard ratios (HRs) with 95%
confidence intervals (CIs) by incident venous thromboembolism type after adjusting
for coexisting risk factors.
Results
The study included 73,993 patients with incident venous thromboembolism (54.1% females;
mean age, 62.3 years). At 6-month follow-up, rates per 100 person-years were 6.80,
6.92, and 9.06 for provoked, unprovoked, and cancer-related venous thromboembolism,
respectively. At 10-year follow-up, corresponding rates were 2.22, 2.84, and 3.70,
respectively. Additionally, at 6-month follow-up, hazard rates of recurrence were
comparable for patients with unprovoked venous thromboembolism 1.01 (95% CI, 0.92-1.11)
and provoked. At 10-year follow-up, unprovoked venous thromboembolism (HR, 1.17; 95%
CI, 1.12-1.23) and cancer-related venous thromboembolism (HR, 1.21; 95% CI, 1.12-1.32)
were associated with higher risk of recurrence compared with that found in provoked
venous thromboembolism.
Conclusions
In this nationwide cohort, patients with cancer-related venous thromboembolism had
the highest risk of recurrence. At 6-month follow-up, there were similar risks of
recurrence for patients with unprovoked and provoked venous thromboembolism. At 10-year
follow-up, recurrence risks were similar for patients with unprovoked venous thromboembolism
and patients with cancer-related venous thromboembolism. High recurrence risks in
all categories indicate that further research is needed to optimize duration of extended
anticoagulation for these patients.
Keywords
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Article info
Footnotes
☆Funding: The Obel Family Foundation partly funded this research by an unrestricted grant. The sponsor had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the writing of the report; or the decision to submit the paper for publication.
✯✯Conflict of Interest: TBL has served as an investigator for Janssen Scientific Affairs LLC and Boehringer Ingelheim, and has been on the speaker bureaus for Bayer, BMS/Pfizer, Roche Diagnostics, Boehringer Ingelheim, and Takeda Pharma. PBN has received speaking fees from Boehringer Ingelheim, BMS/Pfizer, and Bayer AG; consulting fees from Bayer; and grant support from BMF/Pfizer. SZG receives honoraria for consulting activities from Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Janssen, Portola, Agile, eXlthera, and Soleno, and receives research support from BiO2 Medical; Boehringer Ingelheim; BMS; BTG EKOS; Daiichi; the National Heart, Lung, and Blood Institute of the National Institutes of Health; Janssen; and the Thrombosis Research Institute. All other authors have no disclosures to report.
✯Authorship: All authors had access to the data and a role in writing this manuscript.
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