INTRODUCTION: Studies suggest a decreasing risk of recurrent venous thromboembolism (rVTE) in relation to time since the index event. We sought to conduct a meta-analysis examining the time course of rVTE over the first 3-months of anticoagulation. MATERIALS AND METHODS: A literature search of MEDLINE, EMBASE and CENTRAL (through 4/2013) was conducted to identify randomized trials of acute pharmacologic treatment and prevention of rVTE, enrolling ≥200 subjects/treatment arm, requiring anticoagulation for ≥3-months and reporting time-to-objectively-confirmed rVTE. Trials assessing extended-duration treatment, randomizing only cancer patients or not in English were excluded. Treatment arms were divided into monthly and weekly time periods for comparison (months 1-3 and weeks 1-12 after the index event). Treatment arm rVTE rates (per person-year) were pooled using a random-effects approach. RESULTS: Fifteen trials (31 treatment arms; n=27,237) were included. Higher rVTE rates were observed during the first month after the index event (0.19, 95% CI=0.16-0.23) compared to the second (0.05, 95% CI 0.04-0.06; p<0.001 vs. first month) and third months (0.02, 95% CI=0.02-0.03; p<0.001 vs. first month). While the highest rate of rVTE was in week 1 (0.29, 95% CI=0.21-0.37; p<0.01 vs. week 2), rates remained high through the fourth week (between 0.15 and 0.10 events/person-year) before decreasing and stabilizing at week 5 (≤0.05 events/person-year; p<0.01 vs. week 4). CONCLUSIONS: Our findings demonstrate a significant interaction between rVTE rates and time after the index event. High rVTE rates during the 3-4 weeks following the index event emphasize the importance of frequent surveillance during this time and the early optimization of pharmacologic therapy.
INTRODUCTION: Studies suggest a decreasing risk of recurrent venous thromboembolism (rVTE) in relation to time since the index event. We sought to conduct a meta-analysis examining the time course of rVTE over the first 3-months of anticoagulation. MATERIALS AND METHODS: A literature search of MEDLINE, EMBASE and CENTRAL (through 4/2013) was conducted to identify randomized trials of acute pharmacologic treatment and prevention of rVTE, enrolling ≥200 subjects/treatment arm, requiring anticoagulation for ≥3-months and reporting time-to-objectively-confirmed rVTE. Trials assessing extended-duration treatment, randomizing only cancerpatients or not in English were excluded. Treatment arms were divided into monthly and weekly time periods for comparison (months 1-3 and weeks 1-12 after the index event). Treatment arm rVTE rates (per person-year) were pooled using a random-effects approach. RESULTS: Fifteen trials (31 treatment arms; n=27,237) were included. Higher rVTE rates were observed during the first month after the index event (0.19, 95% CI=0.16-0.23) compared to the second (0.05, 95% CI 0.04-0.06; p<0.001 vs. first month) and third months (0.02, 95% CI=0.02-0.03; p<0.001 vs. first month). While the highest rate of rVTE was in week 1 (0.29, 95% CI=0.21-0.37; p<0.01 vs. week 2), rates remained high through the fourth week (between 0.15 and 0.10 events/person-year) before decreasing and stabilizing at week 5 (≤0.05 events/person-year; p<0.01 vs. week 4). CONCLUSIONS: Our findings demonstrate a significant interaction between rVTE rates and time after the index event. High rVTE rates during the 3-4 weeks following the index event emphasize the importance of frequent surveillance during this time and the early optimization of pharmacologic therapy.
Authors: Hanno Riess; Cihan Ay; Rupert Bauersachs; Cecilia Becattini; Jan Beyer-Westendorf; Francis Cajfinger; Ian Chau; Alexander T Cohen; Alok A Khorana; Anthony Maraveyas; Marcos Renni; Annie M Young Journal: Oncologist Date: 2018-04-12
Authors: Michael B Streiff; Giancarlo Agnelli; Jean M Connors; Mark Crowther; Sabine Eichinger; Renato Lopes; Robert D McBane; Stephan Moll; Jack Ansell Journal: J Thromb Thrombolysis Date: 2016-01 Impact factor: 2.300
Authors: Jeffrey A Kline; David H Adler; Naomi Alanis; Joseph R Bledsoe; Daniel M Courtney; James P d'Etienne; Deborah B Diercks; John S Garrett; Alan E Jones; David C Mackenzie; Troy Madsen; Andrew J Matuskowitz; Bryn E Mumma; Kristen E Nordenholz; Justine Pagenhardt; Michael S Runyon; William B Stubblefield; Christopher B Willoughby Journal: Circ Cardiovasc Qual Outcomes Date: 2021-06-21