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Article
October 27, 1997

Recurrence of Venous Thromboembolism in Patients With Familial Thrombophilia

Author Affiliations

From the Department of Clinical Epidemiology and Biostatistics (Drs van den Belt and Prins) and Centre for Haemostasis, Thrombosis, Atherosclerosis, and Inflammation Research (Drs Sanson and Büller), Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; and the Institute of Medical Semeiotics, Padova, Italy (Drs Simioni, Prandoni, and Girolami).

Arch Intern Med. 1997;157(19):2227-2232. doi:10.1001/archinte.1997.00440400077009
Abstract

Background:  Treatment of patients with deep vein thrombosis and an antithrombin or protein C or S deficiency is based on case reports and personal experience.

Objective:  To systematically assess the risk for recurrence of venous thromboembolism after a first episode in patients with these deficiencies, a literature review and retrospective family cohort study were performed.

Methods:  For the literature review, the annual incidence of a first recurrent venous thromboembolism was assessed for each deficiency by dividing the number of venous thromboembolic events by the number of years at risk. For the family cohort study, 1- and 5-year cumulative incidences of first recurrence were calculated based on medical histories taken in relatives of consecutive patients in whom venous thromboembolism and a deficiency were diagnosed.

Results:  For the literature review, the annual incidence of a first recurrent venous thromboembolism in patients with antithrombin or protein S deficiency ranged from 13% to 17% and 14% to 16%, respectively. For the family cohort study, the 1- and 5-year cumulative incidences of recurrent venous thromboembolism were 10% (95% confidence interval, 1%-19%) and 23% (95% confidence interval, 10%-36%), respectively. Warfarin sodium (Coumadin) prophylaxis was associated with 2 venous thromboembolic events in 141 years at risk (1.4% per year), in contrast with 19 events in 709 years at risk (2.7% per year) without prophylaxis (difference, -1.3%; 95% confidence interval, -3.5% to 1.0%).

Conclusions:  The annual incidence of recurrent venous thromboembolism is high during the first years following a first episode, but seems to decline thereafter. Therefore, our results challenge current practice of prescribing lifelong warfarin therapy after a first or second episode of venous thromboembolism in patients with antithrombin or protein C or S deficiency.Arch Intern Med. 1997;157:2227-2232

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