Lisbeth Eischer

Age at first venous thromboembolism and risk of recurrence: a prospective cohort study.

Risk of first venous thromboembolism (VTE) increases with age. We investigated whether age is related to the risk of recurrent VTE. We followed 694 patients for a mean of 40 months after first unprovoked proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and withdrawal of anticoagulants. We excluded patients with natural inhibitor deficiency, lupus anticoagulant, or cancer; patients who required indefinite anticoagulation; pregnant women; and women who had VTE related to female hormone use. The endpoint was symptomatic recurrent VTE. VTE recurred in 152 patients (22%). The adjusted hazard ratio (HR) of recurrence for a 10-year increase in age was 0.94 (95% confidence interval [CI], 0.82-1.08; p = 0.4). Compared with patients aged younger than 47 years (1st tercile of patient population) no significant increase in the risk of recurrent VTE was found among patients 47-61 years old (2nd tercile) or patients older than 61 years (3rd tercile) ([HR, 1.25; 95% CI, 0.78-2.01] and [HR, 0.93l; 95% CI, 0.56-1.53], respectively). Compared to patients older than 80 years, the HR of recurrence among patients younger than 50 years was 1.11 (95% CI, 0.11-10.3; p = 0.9). After 5 years, probability of recurrence was 32% (95% CI, 24%-40%) among patients aged less than 47 years; 21% (95% CI, 15%-28%) among patients 47-61 years old; and 33% (95% CI, 24%-42%) among patients older than 61 years (p = 0.5). Our results show that in patients with first unprovoked proximal DVT and/or PE, risk of recurrence is not related to age at first VTE. Regardless of age, these patients have a high risk of recurrence. Abbreviations: CI = confidence interval, CT = computed tomography, DVT = deep vein thrombosis, HR = hazard ratio, OR = odds ratio, PE = pulmonary embolism, VTE = venous thromboembolism

The risk of recurrence in women with venous thromboembolism while using estrogens: a prospective cohort study

The optimal duration of anticoagulation for women who had venous thromboembolism (VTE) associated with estrogen use is unknown.

Prediction of recurrent venous thromboembolism by clot lysis time: a prospective cohort study.

Venous thromboembolism (VTE) is a chronic disease, which tends to recur. Whether an abnormal fibrinolytic system is associated with an increased risk of VTE is unclear. We assessed the relationship between fibrinolytic capacity (reflected by clot lysis time [CLT]) and risk of recurrent VTE. We followed 704 patients (378 women; mean age 48 yrs) with a first unprovoked VTE for an average of 46 months after anticoagulation withdrawal. Patients with natural coagulation inhibitor deficiency, lupus anticoagulant, cancer, homozygosity for factor V Leiden or prothrombin mutation, or requirement for indefinite anticoagulation were excluded. Study endpoint was symptomatic recurrent VTE. For measurement of CLT, a tissue factor-induced clot was lysed by adding tissue-type plasminogen activator. Time between clot formation and lysis was determined by measuring the turbidity.135 (19%) patients had recurrent VTE. For each increase in CLT of 10 minutes, the crude relative risk (RR) of recurrence was 1.13 (95% CI 1.02–1.25; p = 0.02) and was 1.08 (95% CI 0.98–1.20; p = 0.13) after adjustment for age and sex. For women only, the adjusted RR was 1.14 (95% CI, 0.91–1.42, p = 0.22) for each increase in CLT of 10 minutes. CLT values in the 4th quartile of the female patient population, as compared to values in the 1st quartile, conferred a risk of recurrence of 3.28 (95% CI, 1.07–10.05; p = 0.04). No association between CLT and recurrence risk was found in men. Hypofibrinolysis as assessed by CLT confers a moderate increase in the risk of recurrent VTE. A weak association between CLT and risk of recurrence was found in women only.

Hematocrit and the risk of recurrent venous thrombosis: a prospective cohort study.

Background Venous thromboembolism (VTE) is a multicausal disease which recurs. Hematocrit is associated with a thrombotic risk. We aimed to investigate if hematocrit is associated with the recurrence risk. Methods Patients with a first VTE were followed after anticoagulation. Patients with VTE provoked by a transient risk factor, natural inhibitor deficiency, lupus anticoagulant, homozygous or double heterozygous defects, cancer, or long-term antithrombotic treatment were excluded. The study endpoint was recurrent VTE. Results 150 (23%) of 653 patients had recurrence. Only high hematocrit was significantly associated with recurrence risk [hazard ratio (HR) for 1% hematocrit increase with the third tertile 1.08; 95% CI 1.01–1.15]. No or only a weak association for hematocrits within the first and second tertile was seen (HR 1.03; 95% CI 0.97–1.09, and 1.07; 95% CI 1.00–1.13). Hematocrit was associated with recurrence risk only among women. After five years, the probability of recurrence was 9.9% (95% CI 3.7%–15.7%), 15.6% (95% CI 9.7%–21.2%) and 25.5% (95% CI 15.1%–34.6%) in women, and was 29.2% (95% CI 21.1%–36.5%), 30.1% (95% CI 24.1%–35.7%) and 30.8% (95% CI 22.0%–38.7%) in men for hematocrits in the first, second and third tertile, respectively. Men had a higher recurrence risk (1.9; 95% CI 1.1–2.7; p = 0.03), which dropped by 23.5% after adjustment for hematocrit. Hematocrit was not a significant mediator of the sex-difference in recurrence risk (p = 0.223). Conclusions High hematocrit is associated with the recurrence only in women. The different recurrence risk between men and women is possibly partly explained by hematocrit.

The long-term recurrence risk of patients with unprovoked venous thromboembolism: an observational cohort study

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.

Natural antibodies to oxidation-specific epitopes: Innate immune response and venous thromboembolic disease

Essentials Natural antibodies to oxidation‐specific epitopes have antithrombotic properties. We evaluated the relation between natural IgM and IgG antibodies and the venous thrombosis risk. Risk of recurrent thrombosis was higher in patients with low natural IgM antibody levels. The protective effect of high IgM levels suggests a role of innate immune response in thrombosis.

Risk of venous thromboembolism during rehabilitation of patients with spinal cord injury

Background Patients with spinal cord injury (SCI) are at risk of thrombosis and bleeding. Data on the risks during rehabilitation are inconsistent, and thromboprophylactic strategies are heterogeneous. We aimed to evaluate the thrombotic risk and bleeding events of SCI patients during rehabilitation. Methods We retrospectively collected hospital record data of 263 consecutive SCI patients admitted at a rehabilitation clinic. 78 patients with acute venous thromboembolism (VTE) at the primary center, without acute trauma or lower extremity paresis, less than one month rehabilitation, or reasons for long-term therapeutic anticoagulation, were excluded. All patients received pharmacologic thromboprophylaxis throughout rehabilitation. Primary endpoint was objectively diagnosed VTE; secondary endpoint was bleeding. Results Of 185 patients, 162 (88%) were men; mean age was 47.8 years. 94 patients were tetraplegic, 91 paraplegic. During a mean (±SD) time of 5.1±2.1 months, VTE was diagnosed in 8 patients. After excluding five patients with VTE detected within 2 days after admission, the probability of developing VTE after 6 months of rehabilitation was 2% (95% CI 0–4.4%). Only high D-Dimer upon admission was associated with risk of VTE (adjusted HR 2.3, 95% CI 1.4–4.1). Of 24 bleedings, 14 (64%) occurred at the heparin injection site. Two patients had major bleeding and five had clinically relevant non major bleeding. Conclusion SCI patients are at risk of VTE and bleeding during rehabilitation. Strategies need to be developed to identify these patients in order to initiate adequate anticoagulation. Direct oral anticoagulants, which have a favourable risk-benefit profile and are convenient, should be explored.

Risk of cancer after anticoagulation in patients with unprovoked venous thromboembolism: an observational cohort study

Essentials Data on long‐term cancer risk are controversial in patients with venous thromboembolism (VTE). We assessed long‐term rates and risk factors of cancer in patients with VTE. Cancer risk after anticoagulation is not higher in VTE patients than in the general population. VTE recurrence is not predictive of a future cancer diagnosis.