Maria Ljungqvist1, Kristina Sonnevi2, Annica Bergendal3, Margareta Holmström4, Helle Kieler3, Gerd Lärfars2. 1. Department of Clinical Science and Education, Internal medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. Electronic address: maria.ljungqvist@ki.se. 2. Department of Clinical Science and Education, Internal medicine, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 3. Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. 4. Coagulation Unit, Hematology Centre Karolinska, Department of Medicine Solna Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: It is a matter of debate whether women with an episode of VTE associated with estrogen have a lower risk of recurrence than women with an unprovoked VTE. OBJECTIVES: To identify risk factors for recurrent VTE in women and to assess the risk of recurrent VTE associated with combined oral contraceptives (CHC) or menopausal hormone treatment (HT), compared to surgery-related and unprovoked VTE. PATIENTS/ METHODS: A cohort of 974 women aged 18-64 years with a first episode of VTE were followed-up for a median time of 5.2 years. All women were previously included as cases in the Swedish nation-wide case-control study "Thrombo Embolism Hormone Study" (TEHS). Hazard ratios for recurrence were calculated using univariable and multivariable Cox proportional hazards model. RESULTS: A total of 102 patients (10%) suffered from recurrent VTE. The annual rate of recurrence was 1.0% in patients with surgery/cast, 2.0% in patients with CHC/HT and 3.2% in patients with unprovoked first VTE. Adjusted hazards ratio (HRa) for recurrence was 0.35 (95% CI 0.20-0.61) in women with VT provoked by surgery/cast while women with estrogen-associated VTE had a HRa of 0.70 (95% CI 0.43-1.20) compared to women with unprovoked VTE. CONCLUSION: Women 18-64 years are at low risk of recurrent VTE. Women with hormone associated VTE had a lower risk of recurrence than women with unprovoked VTE, but not as low as surgery/cast provoked VTE.
BACKGROUND: It is a matter of debate whether women with an episode of VTE associated with estrogen have a lower risk of recurrence than women with an unprovoked VTE. OBJECTIVES: To identify risk factors for recurrent VTE in women and to assess the risk of recurrent VTE associated with combined oral contraceptives (CHC) or menopausal hormone treatment (HT), compared to surgery-related and unprovoked VTE. PATIENTS/ METHODS: A cohort of 974 women aged 18-64 years with a first episode of VTE were followed-up for a median time of 5.2 years. All women were previously included as cases in the Swedish nation-wide case-control study "Thrombo Embolism Hormone Study" (TEHS). Hazard ratios for recurrence were calculated using univariable and multivariable Cox proportional hazards model. RESULTS: A total of 102 patients (10%) suffered from recurrent VTE. The annual rate of recurrence was 1.0% in patients with surgery/cast, 2.0% in patients with CHC/HT and 3.2% in patients with unprovoked first VTE. Adjusted hazards ratio (HRa) for recurrence was 0.35 (95% CI 0.20-0.61) in women with VT provoked by surgery/cast while women with estrogen-associated VTE had a HRa of 0.70 (95% CI 0.43-1.20) compared to women with unprovoked VTE. CONCLUSION:Women 18-64 years are at low risk of recurrent VTE. Women with hormone associated VTE had a lower risk of recurrence than women with unprovoked VTE, but not as low as surgery/cast provoked VTE.
Authors: Hanke M G Wiegers; Jannet Knijp; Nick van Es; Michiel Coppens; Stephan Moll; Frederikus A Klok; Saskia Middeldorp Journal: J Thromb Haemost Date: 2022-02-13 Impact factor: 16.036