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Cited by 507Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsCerebral Venous Sinus Thrombosis

Post‐thrombotic syndrome, recurrence, and death 10 years after the first episode of venous thromboembolism treated with warfarin for 6 weeks or 6 months

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SCHULMAN, S., LINDMARKER, P., HOLMSTRÖM, M., LÄRFARS, G., CARLSSON, A., NICOL, P., SVENSSON, E., LJUNGBERG, B. +7 more·2006·Journal of Thrombosis and Haemostasis
DOI 10.1111/j.1538-7836.2006.01795.x
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Abstract

Background The influence of the duration of anticoagulant therapy after venous thromboembolism (VTE) on the long-term morbidity and mortality is unclear.Aim To investigate the long-term sequelae of VTE in patients randomized to different duration of secondary prophylaxis.Methods In a multicenter trial comparing secondary prophylaxis with vitamin K antagonists for 6 weeks or 6 months, we extended the originally planned 2 years follow-up to 10 years. The patients had annual visits and at the last visit clinical assessment of the post-thrombotic syndrome (PTS) was performed. Recurrent thromboembolism was adjudicated by a radiologist, blinded to treatment allocation. Causes of death were obtained from the Swedish Death Registry.Results Of the 897 patients randomized, 545 could be evaluated at the 10 years follow-up. The probability of developing severe PTS was 6% and any sign of PTS was seen in 56.3% of the evaluated patients. In multivariate analysis, old age and signs of impaired circulation at discharge from the hospital were independent risk factors at baseline for development of PTS after 10 years. Recurrent thromboembolism occurred in 29.1% of the patients with a higher rate among males, older patients, those with permanent triggering risk factor - especially with venous insufficiency at baseline - signs of impaired venous circulation at discharge, proximal deep vein thrombosis, or pulmonary embolism. Death occurred in 28.5%, which was a higher mortality than expected with a standardized incidence ratio (SIR) of 1.43 (95% CI 1.28-1.58), mainly because of a higher mortality than expected from cancer (SIR 1.83; 95% CI 1.44-2.23) or from myocardial infarction or stroke (SIR 1.28; 95% CI 1.00-1.56). The duration of anticoagulation did not have a statistically significant effect on any of the long-term outcomes.Conclusion The morbidity and mortality during 10 years after the first episode of VTE is high and not reduced by extension of secondary prophylaxis from 6 weeks to 6 months. A strategy to reduce recurrence of VTE as well as mortality from arterial disease is needed.

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  • Trials in the previous analysis were published before 2004, whereas since then additional prospective studies have reported on the risk for recurrent VTE after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, with several of these studies having followed patients beyond 24 months and some up to 10 years.

    “Furthermore, trials in that analysis were published before 2004, whereas since then additional prospective studies have reported on the risk for recurrent VTE after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, with several of these studies having followed patients beyond 24 months and some up to 10 years.9 10 11 12 13”

    From Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis (2019) · cites this paper as [10]

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Authors
SCHULMAN, S., LINDMARKER, P., HOLMSTRÖM, M., LÄRFARS, G., CARLSSON, A., NICOL, P., SVENSSON, E., LJUNGBERG, B., VIERING, S., NORDLANDER, S., LEIJD, B., JAHED, K., HJORTH, M., LINDER, O., & BECKMAN, M.
Affiliations
  • Karolinska University Hospital (SE)
  • Stockholm South General Hospital (SE)
  • Södertälje Sjukhus (SE)
  • Saint Göran Hospital (SE)
  • Linköping University Hospital (SE)
  • Sjukhuset i Lidköping (SE)
Corresponding author
SCHULMAN, S.
ORCID
Venue
Journal of Thrombosis and Haemostasis
Publisher
Elsevier BV
Published
2006-04
Volume
4
Issue
4
Pages
734-742
ISSN
1538-7836 (ISSN-L)
DOI
10.1111/j.1538-7836.2006.01795.x
OpenAlex
W2031127066
Cited by
507
References
31
Citations by year
2026: 7 · 2025: 18 · 2024: 29 · 2023: 28 · 2022: 24 · 2021: 28 · 2020: 19 · 2019: 18 · 2018: 23 · 2017: 29 · 2016: 37 · 2015: 23 · 2014: 23 · 2013: 18 · 2012: 35
FWCI
23.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thrombosis and Haemostasis (publishedVersion)
  • PubMed (publishedVersion)
Funders
Hjärt-Lungfonden
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
Keywords
post-thrombotic syndrome, venous thromboembolism, secondary prophylaxis, warfarin, vitamin K antagonists, anticoagulation duration, recurrent thromboembolism, long-term mortality, venous insufficiency, proximal deep vein thrombosis, pulmonary embolism, cancer mortality, risk factors, long-term follow-up
MeSH terms
Aged, Anticoagulants, Female, Humans, Male, Middle Aged, Postphlebitic Syndrome, Recurrence, Risk Factors, Thromboembolism, Time Factors, Vitamin K, Warfarin, Venous Thrombosis

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