Vol. 34, No. 1, 2005
Issue release date: November 2005
Pathophysiol Haemos Thromb 2005;34:6–12
(DOI:10.1159/000088541)
Original Paper
Add to my selection

Long-Term Prospective Study of Recurrent Venous Thromboembolism in Patients Younger than 50 Years

García-Fuster M.-J.a · Forner M.-J.a · Fernández C.a · Gil J.b · Vaya A.c · Maldonado L.b
aService of Internal Medicine and bService of Radiology, Hospital Clínico Universitario, cThrombosis and Haemostasis Unit, Hospital La Fe, Valencia, Spain
email Corresponding Author


 goto top of outline Key Words

  • Deep venous thromboembolism
  • Recurrent thromboembolism
  • Antiphospholipid antibodies
  • Thrombosis risk factors
  • Congenital risk factors
  • Acquired risk factors
  • Thrombophilia

 goto top of outline Abstract

Long-term incidence of recurrent venous thromboembolism (VTE) in patients younger than 50 years, not affected by a malignancy or chronic diseases, are poorly characterized. After the initial episode of VTE and cessation of oral anticoagulation, 98 patients, mean age 32.2 ± 9.2 years were followed for a median of 117 months (range 6–165). Congenital risk factors for VTE were present in 36% of patients, acquired persistent (positive antiphospholipid antibodies during the whole follow-up) in 19%, and acquired transitory in 44%. Thirty episodes of recurrent VTE were documented. The cumulative incidence of VTE after 1 year of follow-up was 5.1%, 9.8% after 2 years, 14% after 4 years, and 34.2% after 8 years. In the univariate analysis, the relative risk of recurrent VTE was 2.66 [95% confidence interval (CI) 1.03–6.90] for congenital risk factors, 4.97 (95% CI 1.75–14.0) for persistent acquired (antiphospholipid antibodies), 2.64 (95% CI 1.23–5.66) for male gender and 2.27(1.00–5.15) for body mass index >30 kg/m2. In the multivariate analysis, male gender [hazard ratio (HR) 4.23, 95% CI 1.88–9.77) the presence of congenital factors (HR 3.28, 95% CI 1.25–8.63) and acquired persistent factors (HR 8.50, 95% CI 2.84–25.50) were independent risk factors for recurrent VTE. In patients under 50 years of age without malignancy or underlying chronic disease, hospitalized for an acute thromboembolic event, the presence of antiphospholipid antibodies, congenital defects of coagulation, male sex, and obesity were risk factors for recurrent VTE. These data raise the possibility that selected patients with VTE may require prolonged anticoagulation to prevent recurrent disease.

Copyright © 2005 S. Karger AG, Basel


 goto top of outline References
  1. White RH: The epidemiology of venous thromboembolism. Circulation 2003;107:I-4–I-8.

    External Resources

  2. Kearon C: Natural history of venous thromboembolism. Circulation 2003;107:I-22–I-30.
  3. Lamping DL, Schroter S, Kurz X, et al: Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg 2003;37:410–419.
  4. Kahn SR, Hirsch A, Shrier I: Effect of postthrombotic syndrome on health-related quality of life after deep venous thrombosis. Arch Intern Med 2002;27:1144–1148.
  5. Palareti G, Cosmi B: Predicting the risk of recurrence of venous thromboembolism. Curr Opin Hematol 2004;11:192–197.
  6. Schulman S, Rhedin AS, Lindmarker P, et al: A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. N Engl J Med 1995;332:1661–1665.
  7. Lindmarker P, Schulman S, Sten-Linder M, et al: The risk of recurrent venous thromboembolism in carriers and non-carriers of the G1691A allele in the coagulation factor V gene and the G20210A allele in the prothrombin gene. DURAC Trial Study Group. Duration of Anticoagulation. Thromb Haemost 1999;81:684–689.
  8. Heit JA, Mohr DN, Silverstein MD, et al: Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000;160:761–768.
  9. Cushman M, Tsai A, Heckbert SR, et al: Incidence rates, case fatality, and recurrence rates of deep thrombosis and pulmonary embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE) (abstract). Thromb Haemost 2001;86(suppl 1): OC2349.
  10. Arcelus JI, Caprini JA, Monreal M, et al: The management and outcome of acute venous thromboembolism: a prospective registry including 4,011 patients. J Vasc Surg 2003;38:916–922.
  11. Prandoni P, Lensing AW, Cogo A, et al: The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996;125:1–7.
  12. Hansson PO, Sörbo J, Eriksson H: Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 2000;160:769–774.
  13. Patel RK, Ford E, Thumpston J, et al: Risk factors for venous thrombosis in the black population. Thromb Haemost 2003;90:835–838.
  14. Prandoni P, Cogo A, Bernardi E, et al: A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Thromb Haemost 1993;88:1730–1735.
  15. Levine JS, Branch DW, Rauch J: The antiphospholipid syndrome. N Engl J Med 2002;346:752–763.
  16. García-Fuster MJ, Fernández C, Forner MJ, et al: Risk factors and clinical characteristics at thromboembolic venous disease in young patients: a prospective study. Med Clin (Barc) 2004;123:217–219.
  17. Prandoni P, Cogo A, Bernardi E, et al: A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Thromb Haemost 1993;88:1730–1735.
  18. White RH, Beyth RJ, Zhou H, et al: Major bleeding after hospitalization for deep-venous thrombosis. Am J Med 1999;107:414–424.
  19. Levine MN, Raskob G, Landefeld S, et al: Hemorrhagic complications of anticoagulant treatment. Chest 2001;119:S108–S121.

    External Resources

  20. Pengo V, Lensing AWA, Prins MH, et al: Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257–2264.
  21. Prandoni P, Lensing AW, Prins MH, et al: Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 2002;137:955–960.
  22. Khamashta MA, Cuadrado MJ, Mujic F, et al: The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995;332:993–997.
  23. Schulman S, Svenungsson E, Granqvist S: Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy. Duration of Anticoagulation Study Group. Am J Med 1998;104:332–338.
  24. Ridker PM, Miletich JP, Stampfer MJ, et al: Factor V Leiden and risks of recurrent idiopathic venous thromboembolism. Circulation 1995;92:2800–2802.
  25. Simioni P, Prandoni P, Lensing AW, et al: The risk of recurrent venous thromboembolism in patients with an Arg506→Gln mutation in the gene for factor V (factor V Leiden). N Engl J Med 1997;336:399–403.
  26. Anderson FA Jr, Wheeler HB, Goldberg RJ, et al: A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991;151:933–938.
  27. Kniffin WD Jr, Baron JA, Barrett J, et al: The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994;154:861–866.
  28. Kyrle PA, Minar E, Bialonczyk C, et al: The risk of recurrent venous thromboembolism in men and women. N Engl J Med 2004;350:2558–2563.
  29. Abdollahi M, Cushman M, Rosendaal FR: Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost 2003;89:493–498.
  30. Ridker PM, Goldhaber SZ, Danielson E, et al: Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003;348:1425–1434.
  31. Schulman S, Wahlander K, Lundstrom T, et al: Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximelagatran. N Engl J Med 2003;349:1713–1721.

 goto top of outline Author Contacts

María-José García-Fuster, MD
Service of Internal Medicine, Hospital Clínico Universitario
Avda. Blasco Ibáñez 10
ES–46010 Valencia (Spain)
Tel./Fax +34 96 3862647, E-Mail garciafuster_mjo@gva.es


 goto top of outline Article Information

Received: April 18, 2005
Accepted after revision: July 19, 2005
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 2, Number of References : 31


 goto top of outline Publication Details

Pathophysiology of Haemostasis and Thrombosis

Vol. 34, No. 1, Year 2005 (Cover Date: November 2005)

Journal Editor: Rosing, J. (Maastricht)
ISSN: 1424–8832 (print), 1424–8840 (Online)

For additional information: http://www.karger.com/PHT


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.