Clinical Risk Factors and Timing of Recurrent Venous Thromboembolism During the Initial 3 Months of Anticoagulant Therapy

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Abstract
IN PATIENTS with venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), the 2 most common early sequelae are recurrent VTE and anticoagulant-related bleeding, which occur in about 6% and 3% of patients, respectively, within 3 months of the start of treatment.1,2 Although risk factors for anticoagulant-related bleeding have been extensively investigated in patients with VTE,3-8 there is little information about risk factors for recurrent VTE, which can result in significant morbidity and mortality. Recurrent ipsilateral DVT is associated with a 6-fold increased risk for the postthrombotic syndrome, which can result in chronic leg pain and swelling.9 In addition, recurrent PE that occurs within 3 months of the start of anticoagulant therapy is fatal in 9% to 26% of patients.10 Identifying patients at increased risk for recurrent VTE during anticoagulant therapy, and the time course of recurrence, is clinically relevant for 2 reasons: First, this information may help clinicians decide about the frequency of clinical surveillance and the appropriateness of outpatient treatment of VTE.11-15 Second, early detection and treatment of recurrent DVT, when the size and occlusiveness of the thrombus are less, may result in improved thrombus regression and a decreased risk of the postthrombotic syndrome.16 Moreover, early detection and prompt treatment of recurrent PE with an alternative antithrombotic strategy (eg, thrombolysis or extended heparin therapy) and supportive measures (ie, oxygen and intravenous fluids) may reduce mortality.17

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