02 November 2018

Researchers from Denmark have called for a ‘rethink’ of the categorisation of venous thromboembolism (VTE) as provoked or unprovoked, when considering anticoagulation treatment.

A team from Aalborg University, Denmark, looked at the risk of recurrence after VTE, based on whether it was ‘provoked’ (e.g. by surgery or trauma), ‘unprovoked’ (i.e. without well-known risk factors), or related to cancer.

In a prospective study of 74,000 Danish patients, using data gathered from nationwide health registries between 2000 to 2015, the team showed a substantial risk of recurrence, regardless of the categorisation of VTE.

Rates of recurrence at 6 months were similar in each of the groups, and at 10 years, the recurrence rate was similar for patients who had experience unprovoked and cancer-related VTE, at approximately 20%. The rate of recurrence at 10 years for provoked VTE was greater than 15%.

Full details are published in The American Journal of Medicine.

The team point out that the protective effect of anticoagulation therapy must be carefully weighed against the risk of anticoagulant-related bleeding.

Lead investigator, Dr Ida Ehlers Albertsen, said to optimise anticoagulation therapy, "we may need to rethink the arbitrary categorisation of provoked/unprovoked when risk stratifying patients with incident venous thromboembolism and aim for more nuanced risk stratification.

"Optimal duration of anticoagulation is a pivotal and an on-going scientific and clinical concern. The emergence of the non-vitamin K antagonist oral anticoagulants has changed the landscape for prevention of thrombosis, and contemporary risk stratification approaches may need to be adjusted according to these effective and safer agents."

Professor Samuel Zachary Goldhaber of Harvard Medical School, Boston, Massachusetts, USA, and co-investigator for the study, commented: "Our concept of venous thromboembolism is undergoing a major transition as we increasingly consider it as a chronic illness.”

Source: Albertsen, I.E., Nielsen, P.B., Søgaard, M., Goldhaber, S.Z., Overvad, T.F., Rasmussen, L.H., Larsen, T.B. (2018) “Risk of Recurrent Venous Thromboembolism: A Danish Nationwide Cohort Study”, American Journal of Medicine, available at doi: 10.1016/j.amjmed.2018.04.042


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