Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis
Open accessAbstract
OBJECTIVE: To determine the effect of sex on the risk of recurrent venous thromboembolism in all patients and in patients with venous thromboembolism that was unprovoked or provoked (by non-hormonal factors). Data source Comprehensive search of electronic databases (Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials) until July 2010, supplemented by review of conference abstracts and contact with content experts. STUDY SELECTION: Seven prospective studies investigating an association between D-dimer, measured after anticoagulation was stopped, and disease recurrence in patients with venous thromboembolism. DATA EXTRACTION: Patient level databases were obtained, transferred to a central database, checked, and completed with further information provided by authors. DATA SYNTHESIS: 2554 patients with a first venous thromboembolism had follow-up for a mean of 27.1 (SD 19.6) months. The one year incidence of recurrent venous thromboembolism was 5.3% (95% confidence interval 4.1% to 6.7%) in women and 9.5% (7.9% to 11.4%) in men, and the three year incidence of recurrence was 9.1% (7.3% to 11.3%) in women and 19.7% (16.5% to 23.4%) in men. Among patients with unprovoked venous thromboembolism, men had a higher risk of recurrence than did women (hazard ratio 2.2, 95% confidence interval 1.7 to 2.8). After adjustment for women with hormone associated initial venous thromboembolism, the risk of recurrence remained higher in men (hazard ratio 1.8, 1.4 to 2.5). In patients with provoked venous thromboembolism, occurring after exposure to a major risk factor, recurrence of disease did not differ between men and women (hazard ratio 1.2, 0.6 to 2.4). In women with hormone associated venous thromboembolism and no other risk factors, recurrence was lower than that in women with unprovoked venous thromboembolism and no previous hormone use (hazard ratio 0.5, 0.3 to 0.8). CONCLUSION: In patients with a first unprovoked venous thromboembolism, men have a 2.2-fold higher risk of recurrent venous thromboembolism than do women, which remained 1.8-fold higher in men after adjustment for previous hormone associated venous thromboembolism in women. In patients with a first provoked venous thromboembolism, risk of recurrence does not differ between men and women with or without hormone associated venous thromboembolism. Indefinite anticoagulation may be given greater consideration in men than in women after a first venous thromboembolism.
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- Authors
- Douketis, J., Tosetto, A., Marcucci, M., Baglin, T., Cosmi, B., Cushman, M., Kyrle, P., Poli, D., Tait, R. C., & Iorio, A.
- Affiliations
- St. Joseph’s Healthcare Hamilton (CA)
- Ospedale San Bortolo (IT)
- University of Perugia (IT)
- Addenbrooke's Hospital (GB)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- University of Vermont (US)
- St Anna Children's Hospital (AT)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Glasgow Royal Infirmary (GB)
- McMaster University (CA)
- Corresponding author
- Douketis, J.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2011-02-24
- Volume
- 342
- Issue
- feb24 2
- Pages
- d813-d813
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC3044449
- OpenAlex
- W2073700468
- Cited by
- 278
- References
- 84
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 13 · 2023: 12 · 2022: 21 · 2021: 21 · 2020: 13 · 2019: 24 · 2018: 17 · 2017: 17 · 2016: 21 · 2015: 21 · 2014: 24 · 2013: 22 · 2012: 25
- FWCI
- 5.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Funders
- Oesterreichische Nationalbank
- Fondation Pour La Conservation Du Saumon Atlantique
- National Heart, Lung, and Blood Institute (R01HL058036, R01HL057951, HL-58036, HL-57951)
- 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
- venous thromboembolism, recurrence, sex differences, unprovoked venous thromboembolism, provoked venous thromboembolism, D-dimer, anticoagulation, post-thrombotic syndrome
- MeSH terms
- Adult, Aged, Anticoagulants, Female, Fibrin Fibrinogen Degradation Products, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Risk Factors, Sex Factors, Incidence, Kaplan-Meier Estimate, Venous Thromboembolism
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